Artículos (Medicina Preventiva y Salud Pública)

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Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis
(2017-12-15) Molina, José; Peñalva, Germán; Gil Navarro, María Victoria; Praena, Julia; Lepe Jiménez, José Antonio; Olbrich, Peter; Jiménez-Mejías, Manuel Enrique; Garnacho Montero, José; Valencia, R.; Cordero Matia, María Elisa; Cisneros, José Miguel; García Cabrera, Emilio; Universidad de Sevilla. Departamento de Farmacología, Pediatría y Radiología; Universidad de Sevilla. Departamento de Microbiología; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Medicina; Junta de Andalucía
Background The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved. Methods We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs). Results A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, −216.8 defined daily doses per 1000 OBDs; 95% confidence interval, −347.5 to −86.1), and was sustained during subsequent years (average reduction, −19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, −.003 to .039) reverted toward a decreasing trend of −0.130 per quarter (change in slope, −0.029; −.051 to −.008), and so did the mortality rate (change in slope, −0.015; −.021 to −.008). Conclusions This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use.
Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis
(Elsevier Sci Ltd, 2020) Rodríguez-Baño, Jesús; Pérez-Moreno, M. A.; Peñalva, G.; Garnacho Montero, José; Pinto, C.; Salcedo, I.; Lupión Mendoza, Carmen; Pascual Hernández, Álvaro; Pascual Hernández, Álvaro; Pérez Lozano, María José; Valencia, R.; Cisneros, José Miguel; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Microbiología; Universidad de Sevilla. Departamento de Enfermería
Objectives: Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare sys tems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. Methods: We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quar terly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appro priate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inap propriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. Results: The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) ¼ 3.0%, p < 0.001. Total antimi crobial consumption decreased (QPC ¼ 0.9%, p < 0.001), specifically carbapenems, amoxicillin/clav ulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC ¼ 1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC ¼ 0.2%, p 0.605). Conclusions: To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.
Has the COVID-19 pandemic wiped out the seasonality of outpatient antibiotic use and influenza activity? A time-series analysis from 2014 to 2021
(Elsevier Sci Ltd, 2022-06) Guisado Gil, Ana Belén; Benavente, Regina Sandra; Villegas Portero, Román; Gil Navarro, María Victoria; Valencia, R.; Peñalva, Germán; Cisneros, José Miguel; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Medicina
Objective: To assess the influence of the emergence of severe acute respiratory syndrome coronavirus 2 and the implementation of public health measures on the seasonality of outpatient antibiotic use and their possible association with the incidence of influenza. Methods: We performed a time-series ecological study in 1516 primary care centres of Andalusia, Spain, comparing the coronavirus disease 2019 period (April 2020 to March 2021) with the 6 previous years. We assessed the number of packs and defined daily doses per 1000 inhabitants of antibacterials and key antibiotics commonly used for acute respiratory tract infections and the number of influenza-positive cases per 100 000 inhabitants. We calculated the correlation between variables and analyzed the sea sonal patterns and differences in quarterly antibiotic use. Results: For all quarters, a significant correlation was observed between influenza activity and antibiotic use (Spearman's r ¼ 0.94; p < 0.001). Before the pandemic period, both variables presented similar seasonal patterns. After the start of the pandemic, influenza activity was suppressed and the pattern of antibiotic use flattened into a straight line (R2 ¼ 0.96; p ¼ 0.022) with a quarterly change of 3.9% (p ¼0.007). Total antibiotic use and antibiotics used for treating acute respiratory tract infections showed significant reductions in all quarters compared to the previous year (p < 0.01). Discussion: The coronavirus disease 2019 pandemic has strongly influenced the seasonality of antibiotic use in primary care. The decline in respiratory viruses, among which the influenza virus is a major player that may act as a proxy for general prevalence, is proposed as a reason for the flattening of the seasonal fluctuations of outpatient antibiotic use in our region. Ana Belen Guisado-Gil, Clin Microbiol Infect 2022;28:881.e7e881.e12
Psychological impact of COVID-19 and determinants among Spanish university students
(Frontiers Media, 2023-10-18) Cebrino Cruz, Jesús; Portero de la Cruz, Silvia; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Background: University students are a vulnerable population and faced a significant psychological impact from the COVID-19 pandemic. Therefore, this study aimed to determine the level of fear of COVID-19 among university students and to evaluate the possible relationship between fear of COVID-19 and socio-demographic, health-related determinants, variables related to the COVID-19 and variables related to the psychological impact of the COVID-19 pandemic. Methods: We conducted a cross-sectional study between December 2020 and December 2021 on a sample of 950 university students from two universities in southern Spain. Participants completed a form that collected socio-demographic, health-related and COVID-related variables, a validated questionnaire related to the psychological impact of the COVID-19 pandemic and the fear of COVID Scale (FCV-19S). Descriptive, inferential, and multivariable linear regression analyzes were conducted. Results: The mean FCV-19S score was 14.86 ± 5.16 points. The factors identified as predictors of FCV-19S were being female (p < 0.001), holding religious beliefs (p = 0.04), living in towns with over 10,000 inhabitants (p < 0.01), living with someone vulnerable to COVID-19 (p = 0.02), watching TV to keep informed about COVID-19 (p < 0.01), believing in a low probability of surviving if infected with COVID-19 (p < 0.001), having a higher level of death anxiety (p < 0.001) and suffering from insomnia (p < 0.001). Conclusion: An average fear of COVID-19 score of 14.86 ± 5.16 points has been found among university students in Spain. These findings can aid in identifying specific factors contributing to fear of COVID-19 and in developing coping strategies to alleviate the stress of the pandemic.
Polypharmacy and associated factors: a gender perspective in the elderly Spanish population (2011–2020)
(Frontiers Media, 2023-04-21) Cebrino Cruz, Jesús; Portero de la Cruz, Silvia; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Ministerio de Sanidad. España; Instituto Nacional de Estadística
Background: Few studies have examined the epidemiology of polypharmacy in non-institutionalized elderly adults with regard to sex differences. This study aimed to identify the prevalence of polypharmacy among people ≥65 years old residing in Spain, analyze trends in that prevalence from 2011/12 to 2020, describe the use of the medicines involved and study the possible relationship between polypharmacy and certain sociodemographic, health-related variables, as well as the use of care services by sex. Methods: A nationwide cross-sectional study with 21,841 non-institutionalized people ≥65 years old from the Spanish National Health Survey (2011/2012 and 2017) and the European Health Survey in Spain (2014 and 2020) was performed. We used descriptive statistics, performing two binary logistic regressions to determine the factors related to polypharmacy. Results: The prevalence of polypharmacy was 23.2% (women: 28.1%, men: 17.2%; p < 0.001). The most commonly consumed medicines were analgesics and tranquillizers, relaxants or sleeping pills in elderly women, compared with antihypertensives, antacids and antiulcer drugs and statins for elderly men. In both sexs, the positive predictors of polypharmacy included average, poor and very poor self-perceived states of health, people with overweight and obesity, being severely/non-severely limited due to a health problem, having ≥ three chronic conditions, visits to the family doctor and hospitalization. Among elderly women, negative predictors were alcohol intake, whereas in elderly men positive predictors were being 75–84 years old, being current smokers and having 1, 2 chronic conditions. Conclusion: Polypharmacy has a prevalence of 23.2%, with women accounting for 28.1% and men 17.2% of the total. Knowledge of positive and negative predictors of polypharmacy have important implications for public health efforts to develop or improve health guidelines and strategies for promoting the proper use of medication, particularly in the elderly population by sex.
Uptake patterns and predictors of colorectal cancer screening among adults resident in Spain: A population-based study from 2017 to 2020
(Frontiers Media, 2023-03-13) Portero de la Cruz, Silvia; Cebrino Cruz, Jesús; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Background: Although population screening has improved the early diagnosis of colorectal cancer (CRC), most cases are diagnosed in symptomatic patients. This study aimed to estimate the prevalence and evolution over time of uptake patterns to fecal immunochemical test (FIT) as a screening test for CRC among individuals aged 50–69 in Spain, and to determine the predictive factors for uptake patterns to this type of screening based on sociodemographic, health, and lifestyle characteristics. Methods: A cross-sectional study with 14,163 individuals from the 2017 Spanish National Health Survey and the 2020 European Health Survey was performed, including as the main variable uptake pattern to FIT screening within the last 2 years, with which we analyzed sociodemographic factors, health status and lifestyle habits. Results: 38.01% of participants had undergone FIT in the previous 2 years, and from 2017 to 2020, a significant increase in the uptake rate for CRC was observed (2017: 32.35%, 2020: 43.92%, p < 0.001). The positive predictors to FIT uptake pattern included factors such as being between 57 and 69 years, having a higher educational level or a higher social class, having at least one chronic illness, frequent contact with the primary care physician, alcohol consumption and physical activity, while immigration and smoking habit were negative predictors. Conclusion: In Spain, although the evolution of FIT uptake pattern over time is positive, the prevalence of FIT uptake is still low (38.01%), not reaching the level considered as acceptable in the European guidelines. Moreover, there are disparities in CRC screening uptake among individuals.
Intrapartum transperineal ultrasound used to predict cases of complicated operative (vacuum and forceps) deliveries in nulliparous women
(Wiley, 2017) Sáinz Bueno, José Antonio; García Mejido, José Antonio; Aquise, Adriana; Bonomi, María J.; Borrero González, Carlota; Fuente, Paloma de la; Fernández Palacín, Ana; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Cirugía
Introduction The objective of this study was to investigate the predictive value of intrapartum transperineal ultrasound in the identification of complicated operative (vacuum or forceps) deliveries in nulliparous women. Material and methods Prospective observational study of nulliparous women with an indication for operative delivery who underwent intrapartum transperineal ultrasound before fetal extraction. Managing obstetricians were blinded to the ultrasound data. Intrapartum transperineal ultrasound was performed immediately before blade application, both at rest and concurrently with contractions and active pushing. Operative delivery was classified as complicated when one or more of the following situations occurred: three or more tractions; a third-/fourth-degree perineal tear; significant bleeding during the episiotomy repair; major tear or significant traumatic neonatal lesion. Results A total of 143 nulliparous women were included in the study (82 vacuum-assisted deliveries and 61 forceps-assisted deliveries), with 20 fetuses in occiput posterior position. Forty-seven operative deliveries were classified as complicated deliveries (28 vacuum-assisted deliveries, 19 forceps-assisted deliveries). No differences in obstetric, intrapartum or neonatal characteristics were observed between the study groups, with the following exceptions: birthweight (3229 ± 482 uncomplicated deliveries vs. 3623 ± 406 complicated deliveries; p < 0.003) and number of vacuum tractions (1.4 uncomplicated deliveries, 4.5 complicated deliveries; p < 0.0005). The strongest predictors of a complicated delivery, using the area under the receiver-operating characteristics curve (AUC), were the angle of progression with active pushing (AoP2) (AUC 86.9%) and the progression distance with active pushing (PD2) (AUC 74.5%). The optimal cut-off value for predicting a difficult operative delivery was an AoP2 of 153.5° (sensitivity 95.2%; false-positive rate 5.9%) or PD2 of 58.5 mm (sensitivity 95.2%; false-positive rate 7.1%). Conclusions The sonographic parameters AoP2 and PD2 can be used to predict cases of complicated operative deliveries in nulliparous women.
Slums, social disparities and the COVID-19 pandemic: who were the people truly impacted during the pandemic in Brazil?
(Springer, 2024-12-24) Dias Moura, Heriederson Sávio; Perticarrara Ferezin, Letícia; Bruzadelli Paulino da Costa, Fernanda; Rander Junior, Rosa; Chiodi Toscano de Campos, Mónica; Martins Ribeiro, Natache; Morales, Fátima; Arcencio, Ricardo Alexandre; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Grupo: Universidad de Sevilla. SEJ-066: Mujeres, bienestar y ciudadanía
Background Brazil was heavily impacted by COVID-19 pandemic, which intensified social and health disparities, especially in vulnerable areas such as slums. Therefore, the aim of this study was to investigate which residents of slums in Brazil were most affected by COVID-19 pandemic, with a focus on food insecurity, loss of income, ethnic and racial inequalities, and other social and geographic disparities. Methods We conducted a cross-sectional study among the populations of slums in Brazilian capitals and the Federal District by applying a validated instrument. Inferential descriptive statistics were used, with the application of a logistic regression model. Results The study included 1,227 individuals from slums, most of whom were women, black or mixed-race, single, selfemployed, and users of the Brazilian public healthcare system. Slum residents in the North region experienced the highest income loss, while those in the South region had the lowest, though the South also had the highest food insecurity. People with incomes below one minimum wage were the most affected by income loss, while those with incomes above three minimum wages were the least affected. White individuals were less impacted by food insecurity. Government aid was associated with families experiencing both income loss and food insecurity. Conclusion This study highlights the impact of the COVID-19 pandemic among those with lower incomes living in slums,being most of them black or mixed-race women working in informal employment. It also shows that social and structural disparities have been exacerbated by the pandemic, particularly regarding race/ethnicity, income, and geographic region of residence.
Pregnancy-associated plasma protein a (PAPP-A) as a predictor of third trimester obesity: insights from the CRIOBES Project
(MPDI, 2024-11-15) Gabaldn-Rodriguez, Inmaculada; de Francisco-Montero, Carmen; Menéndez-Moreno, Inmaculada; Balongo-Molina, Alvaro; Gómez-Lorenzo, Ana Isabel; Rodríguez-García, Rubén; Vilches Arenas, Ángel; Ortega Calvo, Manuel; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. CTS-312: Análisis de la demanda sanitaria
Introduction: Our objective in this article was to develop a predictive model for obesity in the third trimester of pregnancy using the plasma and clinical biomarkers that are managed within the Chromosomopathies Programme in the Andalusian Public Healthcare System. Methods: The epidemiological design was observational, of the unmatched case–control type. The geographical environment was the Seville Primary Healthcare District (DSAP Sevilla). The information was collected between 2011 and 2021. The reference cohort consisted of women who had carried a pregnancy to term. The variables and biomarkers studied correspond to those managed within the primary-care Pregnancy Integrated Care Pathway (ICP). Unconditional binary logistic regression (BLR) models were created, with the outcome variable being whether or not the women were obese in their third trimester of pregnancy. Results: A total of 423 controls and 104 cases of obesity were obtained for women in their third trimester who had not been obese in their first trimester. The average age for the sample group (P50) was 34 years old. The final, most parsimonious model included the variables PAPP-A (p = 0.074), beta-hCG (p = 0.1631), and systolic blood pressure (SBP) (p = 0.085). ROC curve = 0.75 (C.I. at 95%: 0.63–0.86). Discussion: The results of this research can only be extrapolated to primary care and to pregnancies with no complications. PAPP-A has been shown in our research to be a significant predictor of obesity risk in the third trimester of pregnancies with no complications (OR = 0.53; C.I. at 95%: 0.39–0.66; p = 0.04 in the single-variant study; OR = 0.58; C.I. at 95%: 0.29–0.93; p = 0.074 in the multi-variant analysis). This predictive capacity is further enhanced from an operational perspective by beta-hCG and 12-week SBP.
Influence of a cardiac rehabilitation programme on the return to work of workers with ischaemic heart disease: Influence of a cardiac rehabilitation programme
(Lippincott Williams & Wilkins, 2024) Delgado-Calderón, Manuel; Jiménez-Ortega, Lara Estefanía; Ladisa, María; Camacho Vega, Juan Carlos; Vilches Arenas, Ángel; Luque Romero, Luis Gabriel; Macías-Toronjo, Israel; Fagundo-Rivera, Javier; Gómez-Salgado, Juan; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Construcciones Arquitectónicas II (ETSIE); Grupo: Universidad de Sevilla. CTS-312: Análisis de la demanda sanitaria; Universidad de Sevilla. SEJ-523: Prevención de riesgos laborales
This study aimed to examine the employment status of patients who have experienced ischemic heart disease one year after undergoing cardiac rehabilitation. For this, a quasi-experimental pre-post study without a control group of active workers aged 18 to 65 years diagnosed with ischemic heart disease and included in a cardiac rehabilitation programme was conducted. Sociodemographic and occupational data, cardiovascular risk factors and clinical-therapeutic data on heart disease were collected. A total of 214 patients were included, of which 115 patients returned to work. Several clinical factors contributing to return to work were identified: preserved left-ventricular ejection fraction (≥55%), < 3 obstructed coronary vessels, and stent revascularisation. Socio-occupational factors that may positively influence return to work were identified: age < 50 years, absence of anxious-depressive symptoms, higher level of education, and occupations with low physical strain. Cardiac rehabilitation is effective in improving cardiac function and health-related quality of life in workers with ischemic heart disease. Return to work and duration of temporary incapacity were associated with clinical-therapeutic variables and psycho-socio-occupational factors, such as type of job, physical strain, anxiety and depression, and age of the worker.
Adherence to the Mediterranean Diet in Association with Self-Perception of Dietary Behavior (Discrepancy between Self-Perceived and Actual Diet Quality): A Cross-Sectional Study among Spanish University Students of Both Genders
(MDPI, 2024-10-03) Béjar Prado, Luis María; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. CTS148: Epidemiología Clínica
Background/Objectives: The Mediterranean diet (MD) is one of the most studied dietary patterns to date and is associated with multiple benefits for health and sustainability. However, paradoxically, adherence to the MD (AMD) has been gradually decreasing in native regions. It is necessary to identify the factors that influence AMD to reverse this trend and to mitigate the negative outcomes (for health and the environment) associated with westernized diets. The objective of this study was to assess how self-perception of dietary behavior influences AMD. Methods: During the 28-day repeated measurement cross-sectional study, participants’ dietary information was obtained from an initial form which established the self-perception of dietary behavior and the e12HR application to establish actual food consumption by individuals. Using the dietary information from both sources, the AMD index was calculated (specifically, the Mediterranean diet Serving Score (MDSS) index). Two categories of self-perception of dietary behavior were defined: Normal/underestimation: difference (MDSS index from initial form—MDSS index from e12HR application) ≤0; and Overestimation: difference >0 (with three subcategories: low (difference = 1–5), moderate (difference = 6–10), high (difference = 11–15)). Results: 139 (111, women; 28, men) Spanish university students were studied, with 98.6% (99.1%, women; 96.4%, men) falling into the overestimation category (they overestimated their dietary behavior); these students had significantly lower MDSS indexes, mean = 6.7, than students in the normal/underestimation category, mean = 12.0. Within the overestimation category, there were significant differences in the MDSS index: low (mean = 8.1), moderate (mean = 6.7), and high (mean = 4.9) subcategories and also differences that were significant in women but not in men. Conclusions: Overestimation of dietary behavior could be associated with lower AMD in all Spanish university students and women.
Access of migrant women to sexual and reproductive health services: a systematic review
(2024) Pérez-Sánchez, María; Immordino, Palmira; Romano, Gaetano; Giordano, Antonio; García Gil, Carmen; Morales, Fátima; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. SEJ-066: Mujeres, Bienestar y Ciudadanía
Background: The number of people living in a different place from their place of birth is increasing year by year. Although women have always been involved in migratory movements, today they are increasingly doing so independently. Women are migrating from the Global South to higher-income countries. One of the challenges they face is access to sexual and reproductive health (SRH) services. Aim: To identify the policy-level barriers that limit the access of migrant women to SRH services, their consequences, and strategies implemented to overcome these barriers. Methods: A systematic review of the literature was undertaken in accordance with the PRISMA statement. A search was undertaken for articles published between 2018 and 2023 focusing on migrant women’s experiences of SRH services. In total, 462 articles were retrieved from PubMed (n = 135), Scopus (n = 94) and Web of Science (n = 233); of these, 28 articles were included in this review. Findings: The most common barrier to SRH services identified in the reviewed articles was lack of information (57 %), followed by language issues (43 %), cultural differences (39 %), economic status (25 %), administrative barriers (25 %) and discrimination (14 %). These barriers led to under-utilisation of maternity services and contraceptive methods. Strategies used by migrant women to overcome these barriers were primarily based on seeking help within their own community or family settings. Conclusion: Strategies at institutional level to improve the access of migrant women to SRH services need to reduce existing barriers, promote health literacy, and train health workers to be culturally sensitive and responsive to the needs of migrant women.
Retraso diagnóstico en enfermedades raras: revisión sistemática
(Ministerio de Sanidad y Consumo, 2022-01-10) Berrocal Acedo, Minerva; Benito Lozano, Juan; Alonso Ferreira, Verónica; Vilches Arenas, Ángel; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Ministerio de Ciencia e Innovación (MICIN). España
Fundamentos: Según el Consorcio Internacional para la Investigación de Enfermedades Raras (IRDiRC) el diagnóstico de una enfermedad rara (ER) conocida debería hacerse en el plazo de un año. El objetivo de esta revisión sistemática fue identificar las evidencias científicas sobre el tiempo que transcurre hasta obtener el diagnóstico en pacientes con ER y conocer si se produce retraso, conforme al objetivo del IRDiRC (más de un año). Métodos: Se realizó una revisión sistemática según criterios PRISMA en las bases de datos PubMed, Scopus y Web of Science (WoS). Se valoró la calidad de los estudios incluidos conforme a la declaración STROBE. Resultados: Se incluyeron 17 artículos orientados a ER específicas, principalmente metabólicas, neurológicas y trastornos que afectan a la inmunidad. Los diseños fueron fundamentalmente transversales, aunque también se incluyeron dos de cohorte retrospectivos. La mayoría de los estudios reflejan que se emplea más de un año en obtener el diagnóstico de estas ER. Conclusiones: La literatura científica que cuantifica el tiempo hasta el diagnóstico en ER es aún escasa y ningún estudio se orienta a estas enfermedades en su conjunto. Según el objetivo del IRDiRC, existe un evidente retraso en el diagnóstico de ER, ya que en la mayoría de los casos se requiere de un tiempo superior a un año. Por tanto, son necesarios nuevos avances en campo de las ER para contribuir a la reducción del tiempo desde la aparición de los síntomas hasta el diagnóstico adecuado.
Prognosis factors of patients undergoing renal replacement therapy
(MDPI, 2023-03-30) Muñoz Terol, José Manuel; Rocha Castilla, José Luis; Castro de la Nuez, Pablo; Egea Guerrero, Juan José; Gil Sacaluga, Luis; García Cabrera, Emilio; Vilches Arenas, Ángel; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Background: Survival in patients with end-stage kidney disease (ESKD) on renal replacement therapy (RRT) is less than that of the general population of the same age, and depends on patient factors, the medical care received, and the type of RRT used. The objective of this study is to analyze the factors associated with survival in patients undergoing RRT. Methods: We conducted a retrospective observational study of adult patients with an incident of ESKD on RRT in Andalusia from 1 January 2008 to 31 December 2018. Patient characteristics, nephrological care received, and survival from the beginning of RRT were evaluated. A survival model for the patient was developed according to the variables studied. Results: A total of 11,551 patients were included. Median survival was 6.8 years (95% CI (6.6; 7.0)). After starting RRT, survival at one year and five years was 88.7% (95% CI (88.1; 89.3)) and 59.4% (95% CI (58.4; 60.4)), respectively. Age, initial comorbidity, diabetic nephropathy, and a venous catheter were independent risk factors. However, non-urgent initiation of RRT and follow-up in consultations for more than six months had a protective effect. It was identified that renal transplantation (RT) was the most influential independent factor in patient survival, with a risk ratio of 0.13 (95% CI (0.11; 0.14)). Conclusions: The receiving of a kidney transplant was the most beneficial modifiable factor in the survival of incident patients on RRT. We consider that the mortality of the renal replacement treatment should be adjusted, taking into account both modifiable and nonmodifiable factors to achieve a more precise and comparable interpretation.
Presenteeism and mental health of workers during the COVID-19 pandemic: a systematic review
(Frontiers Media, 2023-09-14) García Iglesias, Juan Jesús; Gómez Salgado, Juan; Apostolo, João; Rodrigues, Rogério; Costa, Emília Isabel; Ruiz Frutos, Carlos; Martínez Isasi, Santiago; Fernández-García, Daniel; Vilches Arenas, Ángel; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Background: A large number of workers attend work despite being ill. Attending work during sickness can have a number of consequences for the worker (e.g., worsening of physical and mental condition), for co-workers, and for the company, and for service users. Objectives: The aim of this study was to assess the factors influencing presenteeism and mental health of workers during the COVID-19 pandemic. Methods: A systematic review following the PRISMA format was conducted in the PubMed, Scopus, Web of Science (WoS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and ScienceDirect electronic databases in January 2023, using the following key words: Presenteeism, Mental Health, and COVID-19. The eligibility criteria applied were original articles published in English, Spanish, French, German, and Portuguese, workers during the COVID-19 pandemic (data collection date: January 01, 2020 – January 01, 2023), and articles assessing at least one measure of presenteeism and mental health status. Methodological quality was assessed using the critical appraisal tools of the Joanna Briggs Institute. The followed protocol is listed in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42023391409. Results: A total of 25 studies were included in this review recruiting a total of 164,274 participants. A number of factors influencing mental health and sickness presenteeism were identified: (1) mental health-related factors (burnout [in 4 studies], stress [in 9 studies], depression [in 1 study], fear of COVID-19 [in 1 study], no well-being [in 2 studies], etc.); (2) individual factors (health status [in 1 study], being young [in 1 study], workers who experienced interrupted medical care [in 2 studies], having a chronic disease [in 1 study], etc.); (3) factors related to the situation caused by COVID-19 (confinement, symptoms, loss of contract, risk of bankruptcy, etc. [in 1 study each one]); and (4) factors derived from working conditions (organisational support [in 1 study], patient care [in 1 study], work functioning or task performance impairment [in 4 studies], work fatigue [in 2 studies], safety climate [in 1 study], workload [in 1 study], etc.). Conclusion: Identifying the key determinants of presenteeism and understanding the phenomena and origins of sickness presenteeism will help to create a safe working environment and optimal organisational systems to protect vulnerable workers in a pandemic context.
El diseño observacional larvario
(Sociedad Española de Médicos Generales y de Familia, 2023-05-07) Cruz Vela, Carmen; Francisco Montero, Carmen de; Gabaldón Rodríguez, Inmaculada; Vilches Arenas, Ángel; Ortega Calvo, Manuel; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
En epidemiología observacional, el investigador no manipula la realidad de la naturaleza, ni la estresa con mecanismos aleatorios; sencillamente la observa, la analiza, la cuantifica y aporta conclusiones a la comunidad científica. Enfermedades raras, singulares o en serie, cohortes, casos-control y estudios híbridos se pueden enumerar como los tipos fundamentales de diseños observacionales. En las últimas décadas, la regresión logística binaria se ha erigido como un instrumento de análisis esencial para los estudios de casos-control. Mediante una revisión narrativa y un ejercicio de síntesis epistemológica, nosotros definimos un solo tipo de diseño observacional larvario, la cohorte (Stem observational design). Es un concepto de orden abierto y epistemológico.
Dynamic changes in non-invasive markers of liver fibrosis are predictors of liver events after SVR in HCV patients
(MDPI, 2023-05-26) Fernández Álvarez, P.; Guerra Veloz, María Fernanda; Vilches Arenas, Ángel; Cordero Ruiz, Patricia; Bellido Muñoz, Francisco; Caunedo Álvarez, Ángel; Carmona Soria, Isabel; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Objectives: The course of progressive liver damage after achieving sustained virological response (SVR) with direct-acting antivirals (DAAs) remains undetermined. We aimed to determine risk factors associated with the development of liver-related events (LREs) after SVR, focusing on the utility of non-invasive markers. Methods: An observational, retrospective study that included patients with advanced chronic liver disease (ACLD) caused by hepatitis C virus (HCV), who achieved SVR with DAAs between 2014 and 2017. Patients were followed-up until December 2020. LREs were defined as the development of portal hypertension decompensation and the occurrence of hepatocellular carcinoma (HCC). Serological markers of fibrosis were calculated before treatment and one and two years after SVR. Results: The study included 321 patients, with a median follow-up of 48 months. LREs occurred in 13.7% of patients (10% portal hypertension decompensation and 3.7% HCC). Child–Pugh [HR 4.13 (CI 95% 1.74; 9.81)], baseline FIB-4 [HR 1.12 (CI 95% 1.03; 1.21)], FIB-4 one year post-SVR [HR 1.31 (CI 95% 1.15; 1.48)] and FIB-4 two years post-SVR [HR 1.42 (CI 95% 1.23; 1.64)] were associated with portal hypertension decompensation. Older age, genotype 3, diabetes mellitus and FIB-4 before and after SVR were associated with the development of HCC. FIB-4 cut-off values one and two years post-SVR to predict portal hypertension decompensation were 2.03 and 2.21, respectively, and to predict HCC were 2.42 and 2.70, respectively. Conclusions: HCV patients with ACLD remain at risk of developing liver complications after having achieved SVR. FIB-4 evaluation before and after SVR may help to predict this risk, selecting patients who will benefit from surveillance.
Is per capita fish consumption in Latin America aligned with international recommendations for a healthy diet?
(Sociedade Brasileira de Ciência e Tecnologia de Alimentos, 2024) Guzmán-Pincheira, Carla; Andrade-Cuvi, María José; Perez, Juan Carlos Bórquez; Araujo-Silva, Gabriel; Quintero Flórez, Angélica; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
The World Health Organization (WHO) is urging Latin American countries to prioritize the prevention of chronic noncommunicable diseases. Diet is a crucial factor in determining one’s health, and healthy eating recommendations emphasize the consumption of fish at least twice a week due to its protein, vitamin, mineral, and essential fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). This review was designed to compare the status of fish consumption as a source of EPA and DHA fatty acids in some Latin American countries (namely Brazil, Chile, Colombia, and Ecuador), and comparisons with international recommendations within a healthy diet could contribute to the WHO’s call for a focus on preventing the aforementioned diseases in the region. A comprehensive literature search was conducted from January to October 2022 using PubMed, Scopus, EBSCO, and government compendia. Keywords included “fish,” “consumption,” “fatty acids,” “nutrients,” and “Latin America;” and “fish,” “chronic non-communicable diseases,” “all-cause mortality,” “obesity,” “cancer,” “neurodegenerative diseases,” “metabolic diseases,” “diabetes,” “polycystic ovary syndrome,” and “metabolic syndrome.” In countries such as Chile, Brazil, and Colombia, per capita fish consumption falls below WHO’s recommended levels, and the most commonly eaten species do not contain sufficient polyunsaturated fatty acids to provide an optimal intake of EPA and DHA. It is therefore recommended that each country review its dietary guidelines and fish recommendations based on the most commonly consumed species to ensure that their populations obtain the recommended intake of EPA and DHA fatty acids and thus the benefits related to the prevention of chronic noncommunicable diseases.
Work engagement and sense of coherence as predictors of psychological distress during the first phase of the COVID-19 pandemic in Chile
(Elsevier, 2024-05-30) Gómez Salgado, Juan; Delgado García, Diemen; Ortega Moreno, Mónica; Fagundo Rivera, Javier; El Khoury Moreno, Luis; Vilches Arenas, Ángel; Ruiz Frutos, Carlos; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Objectives The aim of this study was to analyse the relationship between sense of coherence, work engagement, and work environment variables as predictors of the level of psychological distress during the first phase of the COVID-19 pandemic in Chile. Methods Cross-sectional descriptive study collected between April 22 and December 16, 2020, using non-probabilistic snowball sampling. The study variables and instruments were socio-demographic variables, work engagement (UWES-9 scale), sense of coherence (Antonovsky SOC-13 scale), and psychological distress (GHQ-12 scale). Multivariate analysis and binary logistic regression were performed including the scores of the three questionnaires and other variables such as effectiveness, safety, stress, health perception, and sex. Finally, the CHAID technique was applied to create a segmentation tree. Results 72.7 % of participants had high levels of psychological distress, more predominantly among women, with work stress and low sense of coherence acting as the most influential mediators in generating psychological distress, and even more so when both were combined. Low work engagement and the availability of safe and effective means to prevent infection were predictors of psychological distress among workers. Conclusion During the first phase of the COVID-19 pandemic, factors that contributed to psychological distress in the Chilean population were identified. These included a fair or poor perception of health, being a woman, work-related stress, availability of safety measures, low level of work engagement, and low level of sense of coherence. Identifying these factors may help prevent similar effects in future phases of the current pandemic or in future pandemics.
Assessment of Osstell ISQ’s reliability for implant stability measurement: A cross-sectional clinical study
(Medicina oral S.L, 2013) Herrero-Climent, Mariano; Santos García, Rocío; Jaramillo Santos, María Reyes; Romero Ruiz, Manuel María; Fernández Palacín, Ana; Lázaro-Calvo, Pedro; Bullon, Pedro; Ríos-Santos, J.V.; Bullon, Pedro; Universidad de Sevilla. Departamento de Estomatología; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública
Resonance frequency analysis (RFA) allows assess implant stability by measuring implant oscillation frequency on the bone. RFA is an objective and non-invasive method for implant stability measurement, although scarce evidence has been provided so far on its reliability. Objectives: Assess the Osstell ISQ system’s reliability (i.e., its measurement reproducibility and repeatability) by means of the intraclass correlation coefficient (ICC) as statistical method. Study Desing: Implants stability registers were completed by means of Osstell ISQ on 85 implants on 23 patients. Six measurements were completed on each implant by means of two different SmartPegs (types I and II); that is, three consecutive measurements with each transducer. Results: Average ISQ was 72.40, 72.22 and 72.79, and 72.06, 72.59 and 72.82 in the first, second, and third meas urements with SmartPegs I and II, respectively. Equal values or differences below three ISQ points were observed in 52.9% and 62.4% of the cases with SmartPegs I and II, respectively. The intraclass correlation coefficient was 0.97 for both SmartPegs, and repeatability and reproducibility also reached 0.97 for both SmartPegs. Conclusions: The RFA system Osstell ISQ presents almost perfect repeatability and reproducibility after intra class correlation coefficient analysis. Osstell ISQ measurements are highly reliable regarding reproducibility. Therefore, one measurement proves enough.

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