Artículos (Medicina Preventiva y Salud Pública)

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

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Idiopathic Neck Pain or Neck Pain of Gastric Origin? A Systematic Review of Rat Experimental Studies on Gastric Harm Pathophysiology and Therapy
(Wiley, 2025-05-22) Oliva Pascual-Vaca, Ángel; Navarro-Carmona, Ignacio; Oliva Pascual-Vaca, Jesús; Riquelme, Inmaculada; Luque Romero, Luis Gabriel; López Millán, José Manuel; Universidad de Sevilla. Departamento de Fisioterapia; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Cirugía; Instituto de Biomedicina de Sevilla (IBIS); Universidad de Sevilla. CTS1043: Salud, Fisioterapia y Actividad Física; Universidad de Sevilla. CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Background: Most cases of neck pain are classified as nonspecific or idiopathic pain and show characteristics such as sensitization, hyperalgesia, limited range of motion, and muscle spasm. Visceral disorders can trigger all those features, and gastric disorders are related to neck pain. Furthermore, stress and anxiety are frequently somaticized as neck pain. However, its pathophysiological link has never been determined. Objectives: To identify the electromyographic and postural response to experimental gastric insult in rats. Methods: A systematic review was undertaken. Searches were conducted in the PubMed and Web of Science databases. The date of publication was not limited. References from included articles were assessed. The sample, experimental intervention, and the results were retrieved from each study. Results: Sixteen studies were included. Acromiotrapezius muscle showed the highest activity to gastric damage, being up to 8–10 times higher than abdominal muscles contraction. Also, a postural response compatible with neck muscles spasm was observed. The threshold for reaching cervical spasm was lowered by the addition of stress, gastritis, dyspepsia, ulcers, diabetes, or inflammation of the colon. Increased visceromotor response persisted even more than 60 days after gastric insult, despite no obvious injury was already visible in the stomach. Furthermore, prenatal or neonatal gastric injury also produced gastric hypersensitivity and increased trapezius spasm in adult rats. On the contrary, neck spasm was reduced by reversing diabetes or blocking the gastric receptors and its afferent pathways. Conclusions: Gastric harm triggers neck muscles spasm. Since many gastric conditions and hypersensitivity are common and tend to be chronic, this may contribute to explain the persistence of neck pain and sensitization in many patients. Prenatal and neonatal gastrointestinal suffering increases trapezius visceromotor response in adults. Furthermore, our findings might contribute to explain why stress is frequently somaticized as neck pain.
Características epidemiológicas del hipotiroidismo en un área del sur de España (Sevilla)
(Sociedad Española de Medicina de Familia y Comunitaria, 2020-06) Mohedano López, Eduardo; Sanchis Osuna, Luis; Luque Romero, Luis Gabriel; González Vargas, José Manuel; Jiménez Hurtado, Rafael; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Instituto de Biomedicina de Sevilla (IBIS)
Objetivo: Determinar la incidencia y prevalencia del hipotiroidismo, estratificándolas por sexo y edad; así como el coste por dosis diaria definida (cDDD) de levotiroxina. Diseño: Estudio observacional, descriptivo, longitudinal y retrospectivo. Emplazamiento: Área Sanitaria Aljarafe-Sevilla Norte. Participantes: Pacientes de cualquier edad y sexo residentes en este Área Sanitaria, que tuvieran prescrita levotiroxina en los años 2015-2017 y al menos dos analíticas consecutivas para el control tiroideo entre 2014-2017. Mediciones Principales: Se determinaron los valores de tirotropina, tiroxina y anticuerpos antiperoxidasa tiroidea facilitados por la Unidad de Laboratorio del Hospital San Juan de Dios. También los datos de prescripción de levotiroxina y su coste por dosis diaria definida, aportados por la Unidad de Farmacia del Distrito Sanitario Sevilla-Norte. Se consideró el coste del valor medio por dosis diaria definida de levotiroxina. Resultados: Se analizaron 45.224 analíticas tiroideas. El 78,4 % pertenecían a mujeres. La edad media fue 49,04 (DE: 21,24) años. La prevalencia (2017) de hipotiroidismo fue del 5,54 % (IC 95 %: 5,45-5,62), la incidencia acumulada de hipotiroidismo clínico fue 2,67 casos/1.000 personas-año (IC 95 %: 2,67-2,68) y del subclínico 52,04 casos/1.000personas-año (IC 95 %: 52,01-52,06). El coste medio anual asociado al consumo de levotiroxina fue de 153.081,13 € (DE:12.662,03) (IC 95 %:152.964,43-153.197,83). Conclusiones: El presente estudio establece los primeros datos de incidencia acumulada de hipotiroidismo en un área de España y presenta una prevalencia mayor en comparación con la mayoría de estudios previos. Asimismo, muestra el coste por dosis diaria definida (cDDD) de levotiroxina, que tuvo una tendencia ascendente en el período 2015-2017.
Máster universitario en estudios de género y desarrollo profesional. Escuela internacional de postgrado. Universidad de Sevilla
(Universidad de Almería, 2022) García Gil, Carmen; Martínez Torres, María del Rocío; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Administración de Empresas y Marketing; Universidad de Sevilla. SEJ548: Big Data and Business Intelligence in Social Media; Universidad de Sevilla. SEJ066: Mujeres, Bienestar y Ciudadanía
En este trabajo se hace un recorrido delorigen, estructura ycaracterísticas del Másteren Estudiosde Género y Desarrollo Profesional desde sus comienzos enel curso académico 2009-2010.El Másterdepende de la Escuela Internacional de Postgrado de la Universidad de Sevilla ysu Programa Académico incluyedos itinerarios:Intervención en procesos educativos y Violencia hacia las mujeres. Destacamosaspectos como:sudoble orientaciónprofesional e investigadora;lainterdisciplinariedad e intersectorialidad de las áreas de conocimientos implicadas en la formaciónacadémica(más de 20 áreas)de su alumnadoy en la dirección del máster;la participación deinstituciones,públicas y privadas, empresas, asociaciones, etc.que colaboran para las prácticas en empresas,que conectan nuestroalumnado con el mundo laboral y profesional; yelPrograma de Doble Máster entre la Universidad de Sevilla y la Pontificia Universidad Católicadel Perú, una de las universidades más prestigiosas de América Latina.Asimismo, también seplanteanretos futuros para su fortalecimiento, como la incorporaciónen el alumnado y cuerpo docente de áreas como las tecnologías, arquitectura, ingenierías, ciencias ambientales,o investigación biomédica básica.Por último, hay que señalarque el master hasido y esun referente en nuestra Universidad para el desarrollo de la igualdad en todos los ámbitos (docente, investigador y de transferencia del conocimiento).
Influence of Place of Birth on Adult Mortality: The Case of Spain
(Springer Nature, 2023-09-07) Aldea, Nestor; Ordanovich, Dariya; Palloni, Alberto; Ramiro, Diego; Viciana Fernández, Francisco José; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; European Research Council (ERC); National Institute on Aging; Ministerio de Ciencia, Innovación y Universidades (MICIU). España; CTS140: Análisis Epidemiológico de las Desigualdades en Salud
We use a unique data set from Spain and we estimate life expectancy at age 50 for males and females by place of residence and place of birth. We show that, consistent with expectations regarding the influence of early conditions on adult health and mortality, the effects of place of birth on adult mortality are very strong, irrespective of place of residence. Furthermore, we find that mortality levels observed in a place are strongly influenced by the composition of migrants by place of birth. This is reflected in a new measure of heritability of early childhood conditions that attains a value in the range 0.42–0.43, implying that as much as 43 percent of the variance in Spain’s life expectancy at age 50 is explained by place of birth. Finally, we find evidence of the healthy migrant effect, that is, positive health selection of migrants, at a regional level.
Effectiveness and safety of oral anticoagulant therapy in a real-world cohort with atrial fibrillation: The SIESTA-A study protocol
(PLOS, 2023-11-29) Montero Balosa, María del Carmen; Limón Mora, J. A.; Leal Atienza, A.; Luque Romero, Luis Gabriel; Aguado Romeo, María José; Isabel Gómez, R.; Molina López, María Teresa; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Instituto de Biomedicina de Sevilla (IBIS)
Introduction: Oral anticoagulants (OACs) are first-line drugs for stroke prevention in patients with atrial fibrillation (AF). The introduction of new lines of therapy with direct oral anticoagulants (DOACs) has led to a decreased use of vitamin K antagonists (VKAs). Comparative analyses of DOACs in clinical trials are scarce and the comparator has mostly been warfarin. Their impact on health outcomes in observational studies has not always been consistent. The aim of this study is to evaluate the effectiveness and safety of DOACs and VKAs in patients with AF using Real-World Data (RWD). Methods and analysis: Population-based retrospective cohort study using RWD from actual practice. Period: January 2012-December 2020. Inclusion criteria: patients with AF who had not taken OACs in the previous 12 months. Exclusion criteria: <40 years, with severe mitral stenosis, or valvular heart disease or aortic and/or mitral valve procedures. Data source: The Andalusian Population Health Database, Spain. Outcome measures: a) Effectiveness: ischaemic stroke, transient ischaemic attack, systemic and pulmonary embolism, and death; b) Safety: gastrointestinal and intracranial haemorrhaging; Independent variables: age, sex, comorbidities, medication and health resource use, CHA2DS2-VASC, HAS-BLED, and analytical tests. Statistical analysis: crude incidence analysis, survival models, Kaplan-Meier, Cox regression analysis adjusted for possible confounding and paired analysis by propensity score matching.
An individual patient data meta-analysis to determine cut-offs for and confounders of NAFLD-fibrosis staging with magnetic resonance elastography
(Elsevier, 2023-09) Liang, Jia-Xu; Ampuero Herrojo, Javier; Niu, Hao; Imajo, Kento; Noureddin, Mazen; Behari, Jaideep; Lacalle Remigio, Juan Ramón; Romero Gómez, Manuel; Universidad de Sevilla. CTS1106: Enfermedades Hepáticas y Digestivas; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria; Instituto de Biomedicina de Sevilla (IBIS)
Background & Aims: We conducted an individual patient data meta-analysis to establish stiffness cut-off values for magnetic resonance elastography (MRE) in staging liver fibrosis and to assess potential confounding factors. Methods: A systematic review of the literature identified studies reporting MRE data in patients with NAFLD. Data were obtained from the corresponding authors. The pooled diagnostic cut-off value for the various fibrosis stages was determined in a two-stage meta-analysis. Multilevel modelling methods were used to analyse potential confounding factors influencing the diagnostic accuracy of MRE in staging liver fibrosis. Results: Eight independent cohorts comprising 798 patients were included in the meta-analysis. The area under the receiver operating characteristic curve (AUROC) for MRE in detecting significant fibrosis was 0.92 (sensitivity, 79%; specificity, 89%). For advanced fibrosis, the AUROC was 0.92 (sensitivity, 87%; specificity, 88%). For cirrhosis, the AUROC was 0.94 (sensitivity, 88%, specificity, 89%). Cut-offs were defined to explore concordance between MRE and histopathology: ≥F2, 3.14 kPa (pretest probability, 39.4%); ≥F3, 3.53 kPa (pretest probability, 24.1%); and F4, 4.45 kPa (pretest probability, 8.7%). In generalized linear mixed model analysis, histological steatohepatitis with higher inflammatory activity (odds ratio 2.448, 95% CI 1.180–5.079, p <0.05) and high gamma-glutamyl transferase (GGT) concentration (>120U/L) (odds ratio 3.388, 95% CI 1.577–7.278, p <0.01] were significantly associated with elevated liver stiffness, and thus affecting accuracy in staging early fibrosis (F0–F1). Steatosis, as measured by magnetic resonance imaging proton density fat fraction, and body mass index(BMI) were not confounders. Conclusions: MRE has excellent diagnostic performance for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Elevated inflammatory activity and GGT level may lead to overestimation of early liver fibrosis, but anthropometric measures such as BMI or the degree of steatosis do not. Impact and implications: This individual patient data meta-analysis of eight international cohorts, including 798 patients, demonstrated that MRE achieves excellent diagnostic accuracy for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Cut-off values (significant fibrosis, 3.14 kPa; advanced fibrosis, 3.53 kPa; and cirrhosis, 4.45 kPa) were established. Elevated inflammatory activity and gamma-glutamyltransferase level may affect the diagnostic accuracy of MRE, leading to overestimation of liver fibrosis in early stages. We observed no impact of diabetes, obesity, or any other metabolic disorder on the diagnostic accuracy of MRE.
Performance of a Non-Invasive System for Monitoring Blood Glucose Levels Based on Near-Infrared Spectroscopy Technology (Glucube®)
(MDPI, 2024-12) Gómez-Peralta, Fernando; Luque Romero, Luis Gabriel; Puppo Moreno, Antonio; Riesgo, Jesús; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Instituto de Biomedicina de Sevilla (IBIS)
Background: The need for frequent blood glucose (BG) monitoring and the inconveniences associated with self-monitoring of BG (SMBG) have driven the development of non-invasive approaches. Methods: This prospective study aimed to investigate the accuracy of glucose level calculation using the near-infrared spectroscopy (NIRS) technology Glucube® system. People with Type 1 diabetes, Type 2 diabetes, prediabetes, and normal glucose metabolism were included. Over one week, individuals performed glucose measurements with the Glucube® system and capillary blood fingersticks with a standard glucometer (Ascensia Contour® Next). To assess the impact of the improvement in dexterity, the accuracy variables were compared with the point-of-care (POC) glucometer Accu-Chek® Inform II in a one-week sub-study. Results: Overall, 105 subjects (mean age 53.8 ± 13.8 years, 50.5% female) participated, resulting in 1914 paired glucose measurements between 49 and 331 mg/dL. Total mean absolute relative difference (MARD) was 20.3%, MARD for values >100 mg/dL was 18.3%, and mean absolute deviation (MAD) for values <100 mg/dL was 24.9%. A total of 97.3% of measurements fell within A+B Parkes zones, and 58.8%, 76.9%, and 88.1% within +−20%, +−30%, or +−40% error, respectively. On completion, 62 participants (59%) fulfilled the one-week prospective sub-study. In this subgroup, the total MARD was reduced between day 1 and day 8 from 22.8 to 18.3% (p = 0.068). The percentages within Zone A were 51.6 vs. 61.2%, Zone B 46.8 vs. 33.9%, and Zone C 1.6 vs. 4.8%, and the sum of Parkes Zones A+B was 98.4 vs. 95.2% (p = 0.311) for day 1 and day 8, respectively. Conclusions: Glucube® is a novel non-invasive system based on NIRS technology for monitoring blood glucose levels. Its promising capabilities support further research.
Nursing participation in health technology assessment: a pending issue?
(Escuela de Enfermería de Ribeirão Preto, 2024-11-04) Lacalle Remigio, Juan Ramón; Benot López, Soledad; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
The term health technologies (HT) it covers not only medical devices, but also medicines, medical and surgical procedures, procedures for the prevention, diagnosis and treatment of health problems, as well as formulas for the organization and management of healthcare. On the other hand, when we talk about health technology assessment (HTA) we refer to a multidisciplinary research process to synthesize the available scientific information. This information concerns the medical, social, economic and ethical consequences of using a health technology. The synthesis must be carried out in a systematic, transparent, unbiased and robust manner.
Implementación y evaluación de un rotatorio formativo en salud bucodental para residentes de medicina de familia y comunitaria. Experiencia piloto
(Elsevier, 2024-06) García-Palma, Alfonso; Luque Romero, Luis Gabriel; Gamero-Merino, María Luisa; de-Marco-Pérez, Fernando; Gómez-Salgado, Juan; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Las enfermedades bucodentales (EBD) se encuentran entre las enfermedades prevenibles más prevalentes a nivel mundial. La consulta de medicina de familia suele ser el primer contacto con las personas que presentan cualquier problema del área oral. En España en el año 2021, se atendieron en Atención Primaria (AP) más de 11 millones de personas por EBD. Según la evidencia disponible, las EBD pueden ser la primera expresión de enfermedades sistémicas y algunas de ellas mantienen una relación bidireccional con ciertas enfermedades crónicas. Dentro del extenso programa de formación de Medicina Familiar y Comunitaria (MFyC) que se desarrolla en cuatro años, no se contempla una formación en los problemas odontológicos de la población4, los cuales son un motivo de consulta frecuente en AP.
Evaluación del manejo y seguimiento de los pacientes diabéticos en la prevención de la retinopatía diabética
(Ministerio de Sanidad, 2024-04) Piñas-García, Purificación; Ruiz Romero, M. V.; Luque Romero, Luis Gabriel; Gómez Jiménez, Carlos Alberto; Castillón Torre, L.; Hernández Martínez, Francisco Javier; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
FUNDAMENTOS: La diabetes mellitus es una enfermedad crónica con alta morbimortalidad que afecta a 537 millones de adultos en el mundo. España es el segundo país europeo en prevalencia, con un 14,8% en población de veinte-setenta y nueve años, con 11,6 casos por cada 1.000 personas/año. La retinopatía diabética (RD) es la quinta causa de pérdida de visión a nivel mundial y la séptima causa de ceguera/discapacidad visual entre afiliados a la Organización Nacional de Ciegos de España (ONCE). La detección precoz de RD previene la ceguera en diabéticos y está condicionada por la hemoglobina glicosilada. El objetivo de este trabajo fue analizar el manejo de los pacientes diabéticos en la comarca del Aljarafe (Sevilla) e identificar oportunidades de mejora en la coordinación de su seguimiento entre el médico de Atención Primaria y el médico oftalmólogo. MÉTODOS: Se realizó un estudio observacional retrospectivo (2016-2019) con los pacientes registrados en el censo de diabéticos de los veintiocho municipios del Aljarafe. Se consultó la historia de salud de Atención Primaria y Hospital, así como el programa de Telemedicina. En cuanto al análisis estadístico, para variables cualitativas se calcularon totales y porcentajes; para variables cuantita- tivas, media y distribución estándar (si distribución normal), y la mediana y cuartiles (distribución no normal). RESULTADOS: Se registraron 17.175 diabéticos en el Aljarafe (5,7% de población); 14.440 pacientes (84,1%) tenían alguna determi- nación de hemoglobina durante el periodo, 9.228 (63,9%) las tenían todas en rango adecuado. Tenían control fundoscópico 12.040 diabéticos (70,1%), y de los que no, 346 (10,6%) tenían todas fuera de rango. Hubo 1.878 (10,9%) pacientes sin control fundoscópico ni metabólico, 1.019 (54,3%) eran mujeres, 1.219 (64,9%) menores de sesenta y cinco años, 1.019 (54,3%) con comorbilidad grave. CONCLUSIONES: La mayoría de los pacientes presentan un cribado adecuado y, más de la mitad, determinaciones en rango. Sin embargo, un porcentaje relevante con ninguna hemoglobina glicosilada en rango carecen de control fundoscópico, y otro grupo me- nor está sin control fundoscópico ni metabólico, con variabilidad intermunicipios. Planteamos mejorar los circuitos de comunicación entre niveles.
Emergency and Urgent Care Network: Analysis of the Stroke Care Line According to Care Times and Outcomes
(SCIENCEDOMAIN International, 2024) Leite, Karina Fonseca de Souza; Andrade, Rubia Laine de Paula; Faria, Mariana Gaspar Botelho Funari de; Isaac, Igor Simões da Silva; Ferreira, Kamila Santos; Lacalle Remigio, Juan Ramón; Camilo, Millene Rodrigues; Monroe, Aline Aparecida; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria
Background: Given the importance of acute stroke care for public health in terms of its burden and consequences like disability and death, evidence-based practice has directed the development of clinical protocols and operational guidelines to care of the populations affected by this pathology. Aim: To evaluate the impact of implementing the stroke care line in the Urgency and Emergency Care Network of a large Brazilian municipality. Methods: This is a retrospective study, conducted between 2014 and 2019 in public health services in Ribeirao Preto, SP, a large municipality of Brazil. Data was collected through secondary sources. A total of 403 patients were included in the study, of which: 172 were treated between 2014 and 2016 and 231 between 2017 and 2019; 118 were served by the mobile pre-hospital care services and 285 by the fixed pre-hospital care services. Data comprise clinical, epidemiological characteristics and severity of cases, as well as stroke care times and outcomes and were analyzed using descriptive techniques, Mann-Whitney and Chi-squared tests. Results: First care provided by a mobile pre-hospital care unit increased from 16.9% to 38.5%. The service times for people undergoing thrombolysis were shorter in the period from 2017 to 2019 compared to 2014 to 2016 in the door-to-needle, stroke onset-to-call, stroke onset-to-ambulance dispatch and regulation-to-door times. Stroke victims treated first by a mobile (ambulance) unit had shorter care times when compared to those who received care in a fixed unit, except in ambulance dispatch-to-door time. No difference was identified in the percentage of outcomes studied in the period from 2017 to 2019 compared to the period from 2014 to 2016. There was a higher craniectomy occurrence in people treated at home than in those attended in health services. The percentage of unfavorable stroke outcomes increased depending on the case severity. Conclusion: The care flow organization with defined responsibilities for each care point through the creation of a care line and the use of pre-established protocols reduced pre- and in-hospital care times; however, they did not have a significative influence on the case outcomes.
Audit of dental reports (II): first phase-II study in a Spanish faculty of dentistry
(Medicina oral S L, 2008) Ríos-Santos, J.V.; Martin García, Pilar; Segura Egea, Juan José; Fernández Palacín, Ana; Bullón Fernández, Pedro; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. CTS941: Patología Dentaria, Operatoria Dental y Endodoncia; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria; Universidad de Sevilla. CTS113: Investigación Etiología y Patogenia Periodontal, Patología Oral y Enfermedades Musculares
As a measure for correction of deficiencies registered through an audit of dental records in the Comprehensive Dentistry Clinic of the Dentistry Faculty of the University of Seville, we elaborated a new format for dental records which was used in 70 patients, carrying out a monitoring audit (Phase V) by applying the same quality criteria and criteria for data collection used in the initial audit (Phase III). We calculated the indices of fulfilment of 46 quality criteria, extending fulfilment percentage to 41 criteria, while statistically significant differences were found in 25 criteria. The standard prefixed as appropriate (75 %) was reached in 29 criteria (against the 12 criteria in which such standard was reached in the first dental audit). It is essential that faculties of dentistry develop systems for dental record revision which may help students achieve the competence of registering dental-care steps appropriately, teachers identify and give response to educational problems, and clinic administration prevent and correct conflicts, at the same time that they all ensure quality in service provision, ease relations with customers and protect users against legal vulnerability.
Dental audit (I): exact criteria of dental records; results of a phase-III study
(Medicina oral S L, 2018) Martin García, Pilar; Ríos-Santos, J.V.; Segura Egea, Juan José; Fernández Palacín, Ana; Bullón Fernández, Pedro; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. CTS941: Patología Dentaria, Operatoria Dental y Endodoncia; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria; Universidad de Sevilla. CTS113: Investigación Etiología y Patogenia Periodontal, Patología Oral y Enfermedades Musculares
Objective: Evaluating the quality of dental records in the Faculty of Dentistry of the University of Seville (Spain). We attempted to collect and/or develop identifiable elements of dental care used to evaluate its appropriateness, as well as to measure its level of filling-in between 1999 and 2004 (Phase III of the record audit). Method: The 46 criteria used to evaluate dental care are shown, measuring--in 50 dental records randomly chosen within a 5-year-time period--their level of filling-in (Phase III of a health audit). Results: A low level of filling-in was observed in all quality criteria defined. No record was found to be free from errors. A maximum of 36 criteria out of 46 was fulfilled (mean of 20.8). Conclusions: The standard of appropriate filling-in was only met in 12 criteria (75%), the results being poor, due to the importance which clearly deficient aspects related to diagnosis and treatment plan have in the process of patient care. For such reason, we suggest a remedial action (Phase IV) developing a new model of dental record and its subsequent re-evaluation (Phase V), which will be subject to analysis in the second part of this paper.
Clinical indicators of periodontal disease in patients with coronary heart disease: a 10 years longitudinal study
(Medicina oral S L, 2012-06) Machuca-Portillo, Guillermo; Segura Egea, Juan José; Jiménez-Beato, Gema; Lacalle Remigio, Juan Ramón; Bullón Fernández, Pedro; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. CTS1000: Odontología en Pacientes Especiales, Médicamente Comprometidos y Hospitalaria; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria; Universidad de Sevilla. CTS113: Investigación Etiología y Patogenia Periodontal, Patología Oral y Enfermedades Musculares
Objectives: There is evidence about a possible relationship existing between periodontal diseases and coronary heart disease. The aim of the present longitudinal study was to investigate the changes in periodontal evolution after etiological periodontal treatment, comparing a healthy control group with another having coronary heart disease. Study design: The study included initially 55 patients of which 44 finished it. They were placed into two groups: Healthy Control Group (HCG) n =9, and Coronary Heart Disease Group (CHDG) n=35. The gingival level (GL), probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP) were measured to compare the periodontal status in both groups. The patients were examined and etiological periodontal treatment was performed and they were then examined at the end of 1 and 10 years. Statistical method: A one way-ANOVA and a MR-ANOVA were established; significance p<0.05. Results: No significant differences between both groups were detected on the first visit (p>0.5). However, at the second visit the CHDG presented a significantly higher PD (p<0.05) and PI (p<0.01). CHDG patients gradually increase PD through time and in comparison to the control group (p<0.041). CHDG patients present a significantly higher CAL loss (p<0.0385) and a significant increase in PI (p<0.0041) at the end of one year, while on the third visit no significant differences were detected in any of these indices. Likewise, a similar fact can be observed on evaluating BOP at the end of ten years causal treatment, a smaller decrease in the cardiac group was observed in regards to the initial values (p<0.001). Conclusion: Patients with coronary heart disease showed a worse evolution of periodontal indices than healthy ones, when referring to probing depth, plaque index and bleeding on probing index.
Assessment of a phenotypic algorithm to detect plasmid-mediated quinolone resistance in Enterobacteriaceae
(Oxford Academic, 2016-03) Rodríguez Martínez, José Manuel; López Cerero, Lorena; Díaz de Alba, Paula; Chamizo López, Francisco Javier; Díaz de Alba, Paula; Chamizo López, Francisco Javier; Polo Padillo, Juan; Pascual Hernández, Álvaro; Universidad de Sevilla. Departamento de Microbiología; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. CTS210: Resistencia a Antimicrobianos; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria
Quinolone resistance in Gram-negative bacteria is the result of mutations in the quinolone resistance-determining region (QRDR) in chromosomally located genes encoding type II topoisomerases and, to a lesser extent, altered permeability. Plasmid-mediated quinolone resistance (PMQR) has also been reported as encoding different proteins: Qnr proteins, acetyltransferase AAC(6′)-Ib-cr variant and the QepA and OqxAB active efflux pumps.
Loss of efficacy and safety of the switch from infliximab original to infliximab biosimilar (CT-P13) in patients with inflammatory bowel disease
(Baishideng Publishing Group Inc, 2018-12-14) Guerra Veloz, María Fernanda; Argüelles Arias, Federico; Laria, Luisa Castro; Maldonado Pérez, Belén; Benítez Roldán, Antonio; Perea Amarillo, Raúl; Merino Bohórquez, Vicente; Calleja, Miguel Ángel; Caunedo Álvarez, Ángel; Vilches Arenas, Ángel; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Farmacología; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria
BACKGROUND Infliximab original has changed the natural history of inﬂammatory bowel diseases (IBD) over the past two decades. However, the recent expiration of its patent has allowed the entry of the first Infliximab biosimilar into the European and Spanish markets. Currently switching drugs data in IBD are limited. AIM To compare the efficacy of infliximab biosimilar, CT-P13, against infliximab original, analyzing the loss of response of both at the 12 mo follow-up in patients with IBD. METHODS An observational study of two cohorts has been conducted. One retrospective cohort that included patients with IBD treated with Infliximab original, and a prospective cohort of patients who were switching from infliximab original to infliximab biosimilar (CT-P13). We had analyzed the overall efficacy and loss of efficacy in patients in remission at the end of one year after treatment with the original drug compared to the results of the year of treatment with the biosimilar. RESULTS 98 patients (CD 67, CU 31) were included in both cohorts. The overall efficacy for infliximab original per year of treatment was 71% vs 68.2% for infliximab biosimilar (P = 0.80). The loss of overall efficacy at 12 mo for infliximab original was 6.6% vs 14.5% for infliximab biosimilar (P = 0.806). The loss of efficacy in patients who were in basal remission was 16.3% for infliximab original vs 27.1% for infliximab biosimilar. Adverse events were 9.2% for infliximab original vs 11.2% for infliximab biosimilar. CONCLUSION The overall efficacy and loss of treatment response with infliximab biosimilar (CT-P13) is similar to that observed with infliximab original in patients who were switching at the 12 mo follow-up. There is no difference in the rate of adverse events.
Systematic review on the use of anticholinergic scales in elderly chronic patients
(Elsevier, 2025-03) Díaz Acedo, Rocío; Villalba Moreno, Ángela María; Santos Ramos, Bernardo; Sánchez Fidalgo, Susana; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Instituto de Biomedicina de Sevilla (IBIS)
Background: The rising prevalence of chronic conditions and polypharmacy in the elderly increases the risk of anticholinergic burden, the cumulative effect of multiple anticholinergic drugs. However, no standard exists for assessing anticholinergic burden in these patients, resulting in various anticholinergic scales with differing methodologies and outcomes. Objectives: To identify existing anticholinergic scales that are applicable to elderly chronic patients and to compare their main characteristics, included drugs and anticholinergic potential scores. In addition, we aim to analyse the previous validation of these scales. Methods: We conducted a systematic review (MEDLINE, EMBASE and Web of Science; PROSPERO ID CRD42024505226; October 2023) for studies on anticholinergic scales applicable to elderly patients with chronic conditions. We also examined the validation of these tools in predicting anticholinergic-related adverse outcomes. Inclusion criteria targeted studies on anticholinergic scales for patients aged ≥65 with chronic conditions, excluding those hospitalized or with specific diseases. Quality assessments utilized JBI tools and SQUIRE 2.0 standards. Results: From 1399 references, 18 anticholinergic scales development studies were included. Different scales varied in creation methodology, with some based on literature, review of previous scales or experimental data. The included studies are heterogeneous in terms of design and results of their quality analysis. For the second objective, 29 validation studies were considered, with mixed associations found between anticholinergic scales and health outcomes. Conclusions: Current anticholinergic scales and validation studies are diverse and show mixed and controversial results, with evidence often coming from retrospective or low-quality studies; indicating the necessity for future research to focus on developing a clinically applicable tool for accurately assessing anticholinergic burden in the elderly with chronic conditions.
Computerized clinical decision support systems for prescribing in primary care: Characteristics and implementation impact. Scoping review and evidence and gap maps
(Elsevier, 2025-01-30) Acosta García, Héctor; Ruano Ruiz, Juan; Gómez García, Francisco José; Sánchez Fidalgo, Susana; Santos Ramos, Bernardo; Molina López, Teresa; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
This study aimed to conduct a scoping review and evidence and gap maps to characterize Clinical Decision Support Systems (CDSS) in primary care, evaluate their implementation and maintenance levels, and identify evidence gaps. Methods: A literature search covering January 2010 to May 2023 was conducted across various databases. Inclusion criteria encompassed studies involving real patients with detailed descriptions of CDSS, including both comparative and descriptive designs within primary care settings. Two independent reviewers screened the references, while four researchers independently extracted data, which included demographics, main findings, and system descriptions. The results were presented using interactive evidence and gap maps. Results: Among 1,447 initial citations, 75 studies met the selection criteria. The identified types of CDSS included adherence to guidelines/local protocols (45 %), antibiotic prescription (16 %), suitability (15 %), and others. Only one system was classified as "intelligent," while 39 % received a complexity rating of 4 on a scale from 1 to 5. Assessment of various outcomes across the studies revealed health outcomes (20 %), economy/resource use (13 %), potentially inappropriate prescription (61 %), adherence to local guidelines/protocols (12 %), and acceptance/use (40 %). Two maps were created: The first one displayed the type of CDSS linked to the type of results measured. The second one showed the type of CDSS and their most relevant characteristics. Data were represented in a dynamic bubble diagram. Conclusion: Current evidence regarding CDSS in primary care is limited and heterogeneous. The identified systems exhibit relative complexity but are not classified as intelligent, primarily focusing on improving prescribing practices through clinical guidelines or prescription aid tools. The outcomes most frequently assessed included potentially inappropriate prescriptions and acceptance/use. The evidence and gap maps provide a user-friendly format for visualizing existing evidence and identifying research gaps in the implementation of CDSS within primary care.
Características sociodemográficas, clínicas y perfil de riesgo anticolinérgico en una residencia sociosanitaria pública: estudio descriptivo
(Fundación Pharmaceutical Care España, 2024) Prado Mel, Elena; Rodríguez Ramallo, Hector; Villalba Moreno, Ángela María; García Cabrera, Emilio; Sánchez Fidalgo, Susana; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Objetivo: analizar las características demográficas, clínicas y funcionales de personas residentes en un centro sociosanitario público. Caracterizar a la población en función del riesgo anticolinérgico según la escala DBI. Metodología: estudio observacional descriptivo de una cohorte de un centro sociosanitario público de Andalucía. Se llevó a cabo desde septiembre hasta diciembre de 2020.Se recogieron variables sociodemográficas, clínicas y funcionales, de farmacoterapia y carga anticolinérgica asociada según la escala DBI. Se realizó un análisis descriptivo general y un otro diferencial en función de la carga anticolinérgica. Resultados: se incluyeron 148 residentes (mediana 73 años [IQR: 15,25]). El 19,8% de la población era analfabeta. El 43,9% presentaba tabaquismo y el 22,3% consumía alcohol a diario. El 50,3% presentaban polifarmacia excesiva (≥10 medicamentos) y el 73,6%. de los pacientes presentaban riesgo anticolinérgico y/sedante según DBI (definido por presentar una puntuación DBI>0). Los principios activos con actividad anticolinérgica y/o sedante más frecuentemente prescritos fueron lorazepam, tramadol, tamsulosina y trazodona. El delirio y la ansiedad, junto con las infecciones de repetición del tracto urinario, fueron más prevalentes en el grupo de residentes que presentaban carga anticolinérgica (p<0,05). Conclusiones: la población del centro sociosanitario presenta un alto índice de analfabetismo, y elevada prevalencia de consumo de tabaco y alcohol. El índice de polimedicación es elevado, así como el porcentaje de pacientes con riesgo anticolinérgico asociado a la farmacoterapia. La ansiedad, el delirium y las ITUs de repetición fueron más prevalentes en la población con carga anticolinérgica. Estudios multicéntricos con mayor número de residentes serían necesarios para confirmar estos hallazgos.
Medication adherence and persistence in heart failure: A protocol for a systematic review and meta-analysis
(Sociedad Española de Farmacia Hospitalaria (SEFH), 2024-08-13) Baéz Gutiérrez, Nerea; Rodríguez Ramallo, Héctor; Sánchez Fidalgo, Susana; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Objective To study medication adherence and persistence among heart failure patients, assess the methods utilised for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes. Methods A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalisation, emergency visits, and mortality. The I2 statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews CRD42024509542. Discussion This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.

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