Public interest in drug-related problems reflected in information search trends: an infodemiological study.

BACKGROUND: The analysis of how people search and "navigate" the internet to obtain health-related information and how they communicate and share this information can provide valuable knowledge about the disease patterns behaviour and health habits of populations. OBJECTIVE: To determine the population's interest in drug-related problems through information search trends. METHOD: A descriptive ecological correlational study, based on obtaining Google Trends data. VARIABLES STUDIED: relative search volume (RSV), evolution over time, milestones and seasonality. RESULTS: The most searched topic was drug overdose, with mean RSV of 56.25 ± 0.65. The highest increase occurred in the contraindication topic (R2 = 0.87, p < 0.001). The main milestone was observed in the drug overdose topic in July 2018 (RSV = 100). A very close relationship was found between adverse drug reaction and contraindication (R = 0.89, p < 0.001). Slight seasonality was noted in the adverse drug reaction (augmented Dickey-Fuller test [ADF] = -1.96), contraindication (ADF = -2.66) and drug interaction (ADF = -1.67) topics, but did not show an epidemiological trend. CONCLUSIONS: The greatest public interest was found in the drug overdose and contraindication topics, which showed a stronger upward trend, although the seasonality study did not show any very notable data or demonstrate epidemiological information search behaviour. The main milestone observed was due to media factors related to the consumption of narcotics. There was a clear difference in English-speaking countries in the use of the drug overdose topic. A correlation between the adverse drug reaction and contraindication topics was confirmed.

Population Interest in Information on Obesity, Nutrition, and Occupational Health and Its Relationship with the Prevalence of Obesity: An Infodemiological Study.

OBJECTIVE: To identify and analyze population interest in obesity, nutrition, and occupational health and safety and its relationship with the worldwide prevalence of obesity through information search trends. METHOD: In this ecological study, data were obtained through online access to Google Trends using the topics "obesity", "nutrition", and "occupational health and safety". Obesity data were obtained from the World Health Organization (WHO) website for crude adult prevalence and estimates by region. The variables studied were relative search volume (RSV), temporal evolution, milestone, trend, and seasonality. The temporal evolution of the search trends was examined by regression analysis (R2). To assess the relationship between quantitative variables, the Spearman correlation coefficient (Rho) was used. Seasonality was verified using the augmented Dickey-Fuller (ADF) test. RESULTS: The RSV trends were as follows: obesity (R2 = 0.04, p = 0.004); nutrition (R2 = 0.42, p < 0.001); and occupational health and safety (R2 = 0.45, p < 0.001). The analysis of seasonality showed the absence of a temporal pattern (p < 0.05 for all terms). The associations between world obesity prevalence (WOP) and the different RSVs were as follows: WOP versus RSV obesity, Rho = -0.79, p = 0.003; WOP versus RSV nutrition, Rho = 0.57, p = 0.044; and WOP versus RSV occupational health and safety, Rho = -0.93, p = 0.001. CONCLUSIONS: Population interest in obesity continues to be a trend in countries with the highest prevalence, although there are clear signs popularity loss in favor of searches focused on possible solutions and treatments, with a notable increase in searches related to nutrition and diet. Despite the fact that most people spend a large part of their time in the workplace and that interventions including various strategies have been shown to be useful in combating overweight and obesity, there has been a decrease in the population's interest in information related to obesity in the workplace. This information can be used as a guide for public health approaches to obesity and its relationship to nutrition and a healthy diet, approaches that are of equal utility and applicability in occupational health.

Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature.

Background: This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs). Methods: The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital." Results: A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations. Conclusion: Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.

Occupational Health Applied Infodemiological Studies of Nutritional Diseases and Disorders: Scoping Review with Meta-Analysis.

(1) Objective: to identify and review existing infodemiological studies on nutritional disorders applied to occupational health and to analyse the effect of the intervention on body mass index (BMI) or alternatively body weight (BW); (2) Methods: This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American, and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Nutrition Disorders, "Occupational Health" and "Infodemiology", applying the filters "Humans" and "Adult: 19+ years". The search was conducted on 29 May 2021; (3) Results: a total of 357 references were identified from the bibliographic database searches; after applying the inclusion and exclusion criteria, a total of 11 valid studies were obtained for the review. Interventions could be categorised into (1) interventions related to lifestyle, physical activity, and dietary changes through education programmes, (2) interventions associated with lifestyle, physical activity, and dietary changes through the use of telemonitoring systems or self-help applications, (3) interventions tied to lifestyle, physical activity, and dietary changes through control and/or social network support groups, and (4) interventions linked to changes in the work environment, including behavioural change training and work environment training tasks. The meta-analysis demonstrated that the heterogeneity present when analysing the results for BMI was 72% (p < 0.01), which decreased to 0% (p = 0.57) when analysing the outcomes for weight, in which case the null hypothesis of homogeneity could be accepted. In all instances, the final summary of the effect was on the decreasing side for both BMI and BW; (4) Conclusions: Despite the high heterogeneity of the results reported, the trend shown in all cases indicates that the intervention methodologies implemented by empowering individuals through Web 2.0 technologies are positive in terms of the problem of overweight. Further implementation of novel strategies to support individuals is needed to overcome obesity, and, at least in the early studies, these strategies seem to be making the necessary change.

Occupational Health of Health-Care Workers with Overnutrition: Scoping Review with Meta-Analysis.

(1) Objective: To review the scientific literature on the impact of interventions to enhance the occupational health of health-care workers with overnutrition. (2) Methods: Scoping review with meta-analysis. Data were obtained by consulting the following bibliographic databases: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS), and Medicina en Español (MEDES). The terms used as descriptors and as text in the title and abstract fields of the records were "health workers", "overnutrition", and "occupational health", using the filters "human", "adult": 19+ years", and "clinical trial". The search update date was January 2023. The documentary quality of the articles was evaluated using the CONSORT questionnaire and the presence of bias was assessed using the Rob 2.0 tool. (3) Results: From the 611 digitally retrieved references, 17 clinical trials were selected after applying the inclusion and exclusion criteria. CONSORT scores ranged from a minimum of 14.6% to a maximum of 91.7%, with a median of 68.8%. According to the SIGN criteria, this review provided "1" evidence with a grade B recommendation. Six different types of intervention were tested, grouped into strategies ranging from a single intervention to a combination of four interventions. The summary effect of the meta-analysis showed significant weight loss, but no association with reduced body mass index. (4) Conclusions: While workplace interventions have been shown to be potentially effective, and strategies using different types of interventions have been proven to be useful in tackling overnutrition, an effective and sustainable solution for changing the behavior of health professionals to tackle overweight and obesity has yet to be identified.

Suitability of indexing terms in the MEDLINE bibliographic database on drug-related problems.

BACKGROUND: For years, there has been controversy about the meaning of medication-related problems (MRPs). This has led several authors to attempt to redefine and classify this term with the aim of using it correctly in the healthcare setting. So far without achieving the desired objective, resulting in erroneous results in the sources of information and thus in malpractice in the sector. OBJECTIVE: To describe and analyze the appropriateness of the existing indexing of scientific publications in the MEDLINE bibliographical database with respect to drug-related problems (DRPs) and to determine whether the descriptors used fulfilled the function of suitably representing this concept. METHODS: A descriptive study was conducted, using the following search terms: Medication Errors; Drug Interactions; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Contraindications, Drug. The sample size was calculated by estimating population parameters in an infinite population (expected value = 0.05; precision of interval = 0.05; level of confidence = 0.95) and the selection method was simple random sampling without replacement, taking the total number of bibliographical references in the database as the basis. The agreement of the indexing with DRPs was evaluated with the coefficient of determination (R2), and the Cohen kappa coefficient was used for the association between the definition of the descriptors and the objective of the article. RESULTS: The 1930 records analyzed showed a total of 2888 different major topics. These major topics were present, with at least one of the five descriptors studied, in 482 (25.0%; 95% CI 23.0-27.0) documentary files, with statistically significant differences between the two phases analyzed (χ2 = 183.8; degrees of freedom (df) = 1; p < 0.001): 1st phase, 295 (13.3%; 95% CI 13.7-16.9) and 2nd phase, 187 (9.7%; 95% CI 8.4-11.0). Overall scientific output with the five descriptors showed a coefficient of determination (R2) of 0.9 (p < 0.001) and the relationship between the objective of the study and the definitions of the five descriptors was 0.9 (p < 0.001). CONCLUSIONS: There was a very good direct exponential trend of the overall scientific output retrieved with the terms associated with DRPs, although the progression of the five descriptors separately did not show a growth model conforming to expectations. There was a moderate agreement between the objective of the study and the definition of each of the five descriptors used and a low relationship between the objective of the study and the concept of DRPs used for this investigation. It is essential to have a descriptor that unifies the terminological diffusion that has existed up till now, since process (causes) and effects (outcomes) have been mixed together under the various definitions and classifications of DRPs found in the studies.

Antibiotic Infographics Available on the Internet: Documentary Quality, Purpose, and Appropriateness as Educational Tools on Antimicrobial Resistance.

Antimicrobial resistance is a major threat to global health in the 21st century. In the age of the internet and social media, infographics may constitute an effective educational resource for transmitting complete messages about antibiotics and antimicrobial resistance and driving behavioural change. We aimed to evaluate the infographics on antibiotics available on the internet in terms of their documentary quality, purpose, and appropriateness as educational tools for explaining the strategic lines defined in the World Health Organization Global Action Plan on Antimicrobial Resistance (GAP-AMR) and for conveying the One Health concept. We obtained the infographics for this cross-sectional study on 4 March 2021 by searching the terms "infographic" and "antibiotic" in Google Images. We verified infographic documentary quality by analysing the image, authorship, title, structure, date, and licence. To evaluate the purpose, we determined whether it coincided with one of the strategic objectives set out in the GAP-AMR. The degree of appropriateness depended on the type of key awareness message on antibiotic use. After obtaining these results, we performed a cross-sectional evaluation to determine how successfully these infographics conveyed the One Heath concept. We selected 247 infographics from 518 references. Of the included infographics, 97 (39%) were produced by public institutions; 58 (23%) read from left to right; 142 (57%) had an educational purpose; 156 (63%) focused on humans; 140 (57%) were subject to copyright; and 97 (39%) had no licence of any type. Almost one quarter (n = 57; 23%) included no key message on proper use of antibiotics. Infographics that included an author/promoter had a significantly higher mean number of messages that those without disclosure of authorship (1.67 vs. 0.50; p < 0.001). The infographics on antibiotics available on the internet are of moderate general quality. Most are produced by public institutions and have a clear and readable layout, but very few have a Creative Commons license to enable their reuse as informative material. The most common purpose is to improve awareness and understanding of antimicrobial resistance; few infographics focus on the remaining four strategic objectives of the GAP-AMR. It would be useful for authors of educational infographics on antibiotics to promote key messages related to antimicrobial resistance and the One Health concept, in accordance with the first objective of the WHO GAP-AMR.

The Effects of the Exogenous Melatonin on Shift Work Sleep Disorder in Health Personnel: A Systematic Review.

(1) Background: To know the medical documentation related to exogenous melatonin in sleep disorders caused by shift work in health personnel; (2) Methods: Systematic and critical review. Data were obtained by looking up the bibliographic data base: MEDLINE (via Pubmed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The used terms, as descriptors and text in the title and abstract record fields, were "Health Personnel", "Melatonin" and "Sleep Disorders", Circadian Rhythm, by using the following filters: "Humans", "Adult: 19+ years" and "Clinical Trial". The search update was in December 2021. The documentary quality of the articles was assessed using the CONSORT questionnaire. (3) Results: Having applied the inclusion and exclusion criteria, 10 clinical essays were selected out of 98 retrieved references. CONSORT scores ranged from a minimum of 6.0 to a maximum of 13. 7 with a median of 10.2. According to the SIGN criteria, this review presented "1-"evidence with a grade of recommendation B. The intervention dose via administration of exogenous melatonin ranged between 1 and 10 mg. It was not mentioned whether the route of administration was by fast or slow absorption. The outcomes showed decreased daytime sleepiness, lessened sleep onset latency, diminished night-time awakenings, increased total sleep period and improved daytime attention in the melatonin-treated group; (4) Conclusions: Exogenously administered melatonin is effective in shift worker health personnel that are suffering from sleep disorders, and given its low adverse effects and tolerability, it might be recommended. A great disparity was evidenced in terms of dose, follow-up periods and type of melatonin, small participant population, same age ranges and young age. Therefore, new trials would be needed to amend these observations in order to have full evidence that is able to ensure the efficacy of exogenous melatonin in the studied population.

Cost-Effectiveness of Therapeutic Drug Monitoring of Anti-TNF Therapy in Inflammatory Bowel Disease: A Systematic Review.

Infliximab and adalimumab are monoclonal antibodies against tumor necrosis factor (anti-TNF) used to manage inflammatory bowel disease (IBD). Therapeutic Drug Monitoring (TDM) has been proven to prevent immunogenicity, to achieve better long-term clinical results and to save costs in IBD treatment. The aim of this study was to conduct a systematic review on cost-effectiveness analyses of studies that apply TDM of anti-TNF in IBD and to provide a critical analysis of the best scientific knowledge available in the literature. The quality of the included studies was assessed using Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Cost-effectiveness of the TDM strategies was presented as total costs, cost savings, quality-adjusted life-years (QALY) and incremental cost-effectiveness ratio (ICER). Thirteen studies that examined the health economics of TDM of anti-TNF in IBD from 2013 to 2021 were included. Eight of them (61.5%) achieved a score between 17 and 23 on the CHEERS checklist. The comparison between the TDM strategy and an empirical strategy was cost saving. The ICER between reactive TDM and an empirical strategy was dominated (favorable) by reactive TDM, whereas the ICER value for proactive TDM compared to an empirical strategy ranged from EUR 56,845 to 3,901,554. This systematic review demonstrated that a TDM strategy is cost-effective or cost-saving in IBD.

Impact of Variation in Pill/Package Appearance of Drugs on Patients' Behavior: A Systematic Review.

OBJECTIVE: This systematic review aims to identify and critically evaluate the available evidence on the impact of switches in pill appearance/packaging on patient's behavior. METHODS: Studies from inception to March 2021 were searched across MEDLINE through PubMed, the Cochrane Library, Embase, and Scopus. Included studies carried out an original evaluation in English or Spanish language that evaluated the impact of switches in pill appearance/packaging on patient's behavior. Two authors independently extracted study data and evaluated studies for methodological quality according to the STROBE guidelines. RESULTS: Ten studies were included, and the mean (SD) number of STROBE criteria satisfied was 17.2 (3.9). Three of 5 studies found a significant association between change in pill appearance and persistence to treatment; the 3 studies that evaluated the impact of a change on adherence to treatment found a significant association; 1 of the 2 studies that evaluated the relationship between a change a clinical outcome found a significant association with the prevalence of uncontrolled blood pressure; and 1 study showed lower rates of switchbacks to the branded product compared with patients who switched to generic drug products, with different appearance. CONCLUSIONS: This systematic review showed an impact of the change in pill/package appearance on patients' behavior in 7 of the 10 studies included. Generic switching may lead to unintended consequences on patients' behavior, mainly regarding adherence to treatment.

[Effects derived from occupational exposure to hazardous substances in pregnant working women: systematic review]. / Efectos derivados de la exposición laboral en las mujeres trabajadoras embarazadas expuestas a sustancias peligrosas: revisión sistemática.

OBJECTIVE: To review the effects derived from occupational exposure on pregnant working women exposed to hazardous substances. METHODS: Critical analysis of the works retrieved by systematic review in MEDLINE (PubMed), EMBASE, Cochrane Library, Scopus, Web of Science, LILACS and MEDES, up to January 2021. The Search Equation was developed by means of the descriptors «Pregnancy¼, «Hazardous Substances¼ and «Occupational Exposure¼, as well as using related Entry Terms and the filters «Humans¼ and «Adult: 19+ years¼. The quality of the articles was evaluated via the STROBE questionnaire and the level of evidence and the grade of recommendation via the SIGN criteria. RESULTS: Out of the 420 references retrieved (366 digitally and 54 manually) and after applying the inclusion and exclusion criteria, 35 articles were selected. The STROBE evaluation obtained a median of 15.32, and the SIGN criteria, a 2+ level of evidence and a C grade of recommendation. Article obsolescence was high (Burton-Kebler half-life: 22.0; Price index: 0.00%). In 25 out of 35 articles, the exposure is to organic solvents. In 22 articles, congenital anomalies were notified. CONCLUSIONS: The reviewed articles exhibited high obsolescence and a degree of evidence and recommendation that did not allow to fully ensure the validity and reliability of the observations made. The results manifested the association between the exposure to dangerous substances and the occurrence of different damages regarding the health of a pregnant worker and her offspring. The most common exposure was to organic solvents and the most observed effect was congenital alterations.

Objetivo: Revisar los efectos derivados de la exposición laboral en las mujeres trabajadoras embarazadas expuestas a sustancias peligrosas. Métodos: Análisis crítico de los trabajos recuperados mediante revisión sistemática en MEDLINE (PubMed), EMBASE, Cochrane Library, Scopus, Web of Science, LILACS y MEDES, hasta enero 2021. La ecuación de búsqueda se formuló́ mediante los descriptores «Pregnancy¼, «Hazardous Substances¼ y «Occupational Exposure¼, utilizando también los Entry Terms relacionados y los filtros: «Humans¼ y «Adult: 19+ years¼. La calidad de los artículos se evaluó mediante el cuestionario STROBE y el nivel de evidencia y grado de recomendación mediante los criterios SIGN. Resultados: De las 420 referencias recuperadas (366 de forma digital y 54 manual), aplicando los criterios de inclusión y exclusión, se seleccionaron 35 artículos. La evaluación mediante STROBE dio mediana de 15,32 y según los criterios SIGN se obtuvo grado de evidencia 2+ y recomendación C. La obsolescencia fue elevada (semiperiodo de Burton-Kebler: 22,00; índice de Price: 0,00%). En 25 de los 35 estudios revisados la exposición fue a disolventes orgánicos. En 22 artículos se notificó alteraciones congénitas. Conclusiones: Los trabajos revisados presentaron un alto índice de obsolescencia y un grado de evidencia y recomendación que no permitió asegurar por completo la validez y fiabilidad de las observaciones realizadas. Los resultados mostraron la asociación entre la exposición a sustancias peligrosas con la aparición de diferentes daños para la salud de la trabajadora embarazada y su descendencia. La mayor exposición fue a los disolventes orgánicos y el efecto más observado las alteraciones congénitas.

Trends and Seasonality of Information Searches Carried Out through Google on Nutrition and Healthy Diet in Relation to Occupational Health: Infodemiological Study.

This study aimed to analyze and relate the population interest through information search trends on Nutrition and Healthy Diet (HD) with the Occupational Health (OH). Ecological and correlational study of the Relative Search Volume (RSV) obtained from Google Trends query, segmented in two searched periods concerning antiquity; date of query: 20 April 2021. The RSV trends for the analyzed three Topics were: Nutrition (R2 = 0.02), HD (R2 = 0.07) and OH (R2 = -0.72). There was a good positive correlation between Nutrition and OH (R = 0.56, p < 0.001) and a moderate one between HD and OH (R = 0.32, p < 0.001). According to seasons, differences were verified between RSV means in the Topics HD (p < 0.01) and OH (p < 0.001). Temporal dependence was demonstrated on Nutrition searches (Augmented Dickey-Fuller = -2.35, p > 0.05). There was only a significant relationship between the RSV Topic HD (p < 0.05) for the Developing and Least Developed countries. The data on the analyzed RSV demonstrated diminishing interest in the search information on HD and OH as well as a clearly positive trend change in recent years for Nutrition. A good positive correlation was observed between the RSV of nutrition and OH whereas the correlation between HD and OH was moderate. There were no milestones found that may report a punctual event leading to the improvement of information searches. Temporal dependence was corroborated in the RSV on Nutrition, but not in the other two Topics. Strangely, only an association was found on HD searches between the Developing and Least Developed Countries. The study of information search trends may provide useful information on the population's interest in the disease data, as well as would gradually allow the analysis of differences in popularity, or interest even between different countries. Thus, this information might be used as a guide for public health approaches regarding nutrition and a healthy diet at work.

Influence of Nutrition, Food and Diet-Related Interventions in the Workplace: A Meta-Analysis with Meta-Regression.

OBJECTIVE: To review the scientific literature on the influence of verified nutrition, food and diet interventions on occupational health. METHOD: This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Diet, Food, and Nutrition" and "Occupational Health" and applying the filters "Clinical Trial", "Humans" and "Adult: 19+ years"; the search was conducted on 29 May 2021. RESULTS: A total of 401 references were retrieved from the bibliographic databases, with an additional 16 identified through a secondary search; among the studies retrieved, 34 clinical trials were selected after applying the inclusion and exclusion criteria. The interventions were grouped into seven categories: (1) dietary interventions associated with exercise or educational programs; (2) individual environmental interventions or other educational actions; (3) educational interventions oriented toward lifestyle, dietetics, physical activity and stress management; (4) economic incentives; (5) multicomponent interventions (combination of mindfulness, e-coaching and the addition of fruits and vegetables); or dietary interventions (facilitating greater food supply in cafeterias); or interventions focused on physical exercise. CONCLUSIONS: Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions-preferably including several strategies-have been demonstrated, in general, as useful for combating overweight and obesity. From the meta-regression study, it was observed that the interventions give better results in people who presented high Body Mass Index (BMI) values (obesity). In contrast, intervention 2 (interventions related to workplace environment) would not give the expected results (it would increase the BMI).

Assessing the risk of using hazardous drugs in Hospital-at-Home Units: a big data study protocol.

OBJECTIVE: This article describes a study protocol for the implementation of quality and traceability control in the hazardous  medication circuit through an analysis of risks and the development and  introduction of a Big Data-based software application aimed at performing  a continuous and dynamic audit of the whole system. Method: A standardized graphical modeling tool called Business Process Model Notation will be used to generate a detailed description of each of the stages in the hazardous medication circuit with a view to  ensuring full traceability of the system. The information on each stage will  be collected in a flowchart, which will be used -together with each event's likelihood of occurrence and severity- as a basis to calculate the  criticality index of the different control points established and to determine  any control measures that may be required. The flowcharts will  also be used to develop the technological support needed to capture  all such data as may be relevant to the model. Proper quality control of the process will be ensured by client software agents intended to allow  automatic applica tion of efficient data processing tools at the different  phases. In addition, Big Data methodologies, in particular machine  learning, will be used to develop algorithms based on the repository of  generated data to come up with patterns capable of improving the  protocols to be applied. Lastly, proper operation of the process will be  ensured by means of clinicalpharmaceutical verification and a full  technical-documentary review of control and registration systems. CONCLUSIONS: The development of a risk management system based on  mobile technology will allow integration of hazardous drugs into a standardized system, ensuring the safety, quality, and traceability of the hazardous medication handling process.

Objetivo: Describir el protocolo del estudio para la instauración del control del proceso de los medicamentos peligrosos que asegure la calidad y su trazabilidad, mediante el análisis de riesgos, desarrollando e  Implantando una herramienta informatizada que, gracias a la utilización de técnicas de big data, permita conocer y auditar el conjunto del sistema de  forma continua y dinámica.Método: Mediante los procesos de notación gráfica normalizada Business Process Model Notation se desarrollarán los flujogramas  Específicos que permitan conocer las etapas del proceso de los  Medicamentos peligrosos que determinen la trazabilidad total del sistema.  Cada una de las etapas será recogida en los cuadros de gestión, donde a  través de la probabilidad del suceso y su gravedad se calculará el índice de criticidad de cada punto de control que se determine, y se establecerán las medidas de control. A partir de los cuadros de gestión se desarrollará el  soporte tecnológico para la captura de todos los datos que sean  pertinentes al modelo. Para asegurar el control de la calidad del proceso se optará por agentes software cliente, que permitan en fases posteriores  aplicar herramientas eficientes en el procesamiento de datos de modo  automático. A partir de aproximaciones metodológicas del big data, y en  particular del ámbito de machine learning, se desarrollarán algoritmos  sobre el repositorio de datos generado para poder obtener patrones que  permitan mejorar los protocolos de aplicación. Por último, para asegurar el funcionamiento del proceso se realizará la verificación clínico-farmacéutica  y la revisión completa, técnico-documental, de los sistemas de control y  registro.Conclusiones: La generación del sistema de gestión de riesgos mediante  tecnología móvil permitirá integrar los medicamentos peligrosos en un sistema normalizado, con el fin de mejorar la seguridad, calidad y  trazabilidad del proceso de manipulación de los medicamentos peligrosos.

Is Energy Expenditure or Physical Activity Considered When Energy Intake Is Measured? A Scoping Review 1975-2015.

The health-transitions humans have delivered during the 20th Century associated with the nutrition is that from undernutrition to obesity, which perseveres in the current years of the 21st Century. Energy intake (EI) is a contributing factor and therefore a fascination in nutritional sciences. However, energy expenditure (EE) has not been usually considered as a conjoint factor. Thus, this study aimed to review if studies on adults consider data on dietary intake, specifically EI, and included data on EE and physical activity (PA). A search of MEDLINE from 1975 to December 2015 was managed. Our scoping review consisted of keywords related to EI, dietary allowances, and nutritional requirements. From 2229 acknowledged articles, 698 articles were finally taken fulfilling inclusion and quality criteria. A total of 2,081,824 adults (53.7% females) were involved, and most studies had been conducted in EEUU (241), Canada (42), Australia (30), Japan (32), and Brazil (14). In Europe, apart from UK (64), the Netherlands (31) and France (26) led the classification, followed by Sweden (18), Denmark (17), and France (26). Mediterranean countries are represented with 27 studies. A total of 76.4% did not include EE and 93.1% did not include PA. Only 23.6% of the studies contained both EI and EE. A large methodological diversity was perceived, with more than 14 different methods regarding EI, and more than 10 for EE. PA was only analyzed in scarce articles, and scarcely considered for interpretation of data and conclusions. Moreover, PA was often measured by subjective questionnaires. Dietary surveys show a large diversity regarding methodology, which makes comparability of studies difficult. EE and PA are missing in around 80% of studies or are not included in the interpretation of results. Conclusions regarding EI or diet adequacy in adults should not be taken without analyzing EE and PA.

Perception of risk of exposure in the management of hazardous drugs in home hospitalization and hospital units.

OBJECTIVE: To assess the perception of risk of exposure in the management of hazardous drugs (HDs) through home hospitalization and hospital units. MATERIAL AND METHODS: A questionnaire was released, at the national level, to health professionals with HD management expertise. Questionnaire included 21 questions that were scored using a Likert scale: 0 (null probability) to 4 (very high probability). The internal consistency and reliability of the questionnaire were calculated using Cronbach's alpha and the intraclass correlation coefficient, respectively. RESULTS: 144 questionnaires (response rate 70.2%) were obtained: 65 (45.1%) were nurses, 42 (28.9%) occupational physicians, and 37 (26.1%) were pharmacists. Cronbach's alpha was 0.93, and intraclass correlation coefficient was 0.94 (95% CI 0.91-0.97; p-value < 0.001). The mean probability was 1.95 ± 1.02 (median 1.9; minimum: 0.05; 1st quartile 1.1; 3rd quartile 2.6; and maximum 4). Differences were observed in scoring among professional groups (occupational physicians versus nurses (1.6/2.1, p = 0.044); pharmacists versus nurses (1.7/2.1, p = 0.05); and occupational physicians versus pharmacists (1.6/1.7, p = 0.785), due mainly to the administration stage (p = 0.015). CONCLUSIONS: The perception of risk of exposure was moderate, being higher for nurses. It would be advisable to integrate HDs into a standardized management system (risk management model applicable to any healthcare center) to improve the safety of health professionals.

Dimensions of Community Assets for Health. A Systematised Review and Meta-Synthesis.

Since Aaron Antonovsky's salutogenesis theory and Morgan and Ziglio's health assets model were first proposed, there has been a growing concern to define the resources available to the individual and the community to maintain or improve health and well-being. The aim of the present study was to identify the dimensions that characterise community assets for health. To this end, we conducted a systematised review with a meta-synthesis and content analysis of research or projects involving asset mapping in the community. Articles that met our eligibility criteria were: (1) based on the salutogenic approach and (2) described an assets mapping process and among their results, explained what, how and why particular community assets for health had been selected. The search included primary studies in the published and grey literature which were selected from websites and electronic databases (Web of Science, MEDLINE, Scopus, EBSCOhost, Dialnet, SciELO). Of the 607 records examined by a single reviewer, 34 were included in the content analysis and 14 in the qualitative synthesis. Using an inductive process, we identified 14 dimensions with 24 categories, for which in-depth literature reviews were then carried out to define specific indicators and items. These dimensions were: utility, intention, previous use, accessibility ("circumstances-opportunity-affordability"), proximity-walkability, connectivity, intelligibility (visibility, transparency), identity (uniqueness, appropriability, attachment), design (configuration, functionality, comfort), safety (objective/subjective), diversity, the dimension of public and private, and sustainability (which includes maintenance, profitability or economic sustainability, environmental sustainability, centrality-participation and equity-inclusiveness).

[Malignant Skin Neoplasms in Workers in the Fishing Industry: Systematic Review]. / Lesiones malignas de la piel en trabajadores del sector pesquero: Revisión sistemática.

OBJECTIVE: To review the scientific literature related to the effects of occupational exposure to risk factors for skin neoplasms in fishery workers. METHOD: Critical analysis of the papers recovered through systematic review from en MEDLINE (PubMed), EMBASE, The Cochrane Library, Scopus, Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). STOROBE guidelines were followed to evaluate their quality. RESULTS: After attributing inclusion and exclusion criteria to the search, 11 articles were accepted for review and critical analysis. In 7 of them, a statistically significant association was obtained between skin neoplasia and occupational exposure in fishermen. CONCLUSIONS: Despite having found studies that were significant in terms of the relationship of malignant lesions and exposure to ultraviolet radiation in the workplace, some of them did not control possible biases, therefore the results should be taken with caution.

OBJETIVO: Revisar la literatura científica relacionada con los efectos de la exposición ocupacional a factores de riesgo para neoplasias cutáneas en trabajadores del sector pesquero. MÉTODO: Análisis crítico de los trabajos recuperados mediante revisión sistemática en MEDLINE (PubMed), EMBASE, The Cochrane Library, Scopus, Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). Se evaluó la calidad de los artículos seleccionados mediante el cuestionario STROBE. RESULTADOS: Al atribuir los criterios de inclusión y exclusión a la búsqueda, se aceptaron 11 estudios para su revisión. En 7 de ellos, se obtuvo una asociación estadísticamente significativa entre neoplasia cutánea y exposición ocupacional.  CONCLUSIONES: Se observa una relación entre lesiones malignas y exposición a radiación ultravioleta en el ámbito laboral, no obstante, la existencia de posibles sesgos hace que los resultados deban de tomarse con precaución.

Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews.

INTRODUCTION AND HYPOTHESIS: In recent years the number of caesarean sections has increased worldwide for different reasons. to review the scientific evidence relating to the impact of the type of delivery on pelvic floor disorders (PFDs) such as urinary and faecal incontinence and pelvic organ prolapse. METHODS: A review of systematic reviews and meta-analysis, drawn from the following databases: MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud/Latin American and Caribbean Health Sciences Literature) prior to January 2019. The directives of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in assessing article quality. RESULTS: Eleven systematic reviews were evaluated, 6 of which found a significantly decreased risk of urinary incontinence associated with caesarean section and 3 meta-analyses showed a significant reduction in POP for caesarean section, compared with vaginal delivery. Of 5 reviews that examined delivery type and faecal incontinence, only one indicated a lower incidence of faecal incontinence associated with caesarean delivery. However, most of the studies included in these reviews were not adjusted for important confounding factors and the risk of PFDs was not analysed by category of caesarean delivery (elective or urgent). CONCLUSION: When compared with vaginal delivery, caesarean is associated with a reduced risk of urinary incontinence and pelvic organ prolapse. These results should be interpreted with caution and do not help to address the question of whether elective caesareans are protective of the maternal pelvic floor.

[Impact and prestige indicators of SciELO network health sciences journals: comparative study.] / Indicadores de impacto y prestigio de las revistas de ciencias de la salud indizadas en la Red SciELO: estudio comparativo.

OBJECTIVE: The use of bibliometric indicators to measure the quality of scientific journals is a general practice in all areas of science. The WoS and Scopus databases continue to be the reference sources to obtain bibliographic indicators. Others such as SciELO network offer indicators about Ibero-American science, which are scarcely collected in WoS and Scopus. The aim of this work was to analyze the association of the indicators proposed by SciELO for health sciences journals, with the most widely used impact and indicators and to study the complementarity of the existing prestige indicators. METHODS: Analytical correlational study between SciELO indicators, with impact and prestige indicators from Journal Citation Report, Scopus and Web of Science. The results refer to 2018, the most recent and complete data available. Association between the qualitative variables was analyzed using the chi-square test, and the analysis of variance (ANOVA) was performed for the quantitative variables using the Tukey method as a post hoc test. To obtain the relationship between quantitative variables, Pearson's correlation coefficient was used and Spearman's coefficient for ordinal variables. The level of significance used in all the hypothesis tests was α≤0.05. RESULTS: The SciELO Impact Factor showed a weak correlation both, with Journal Citation Report (R=0.36; p=0.003), and Scopus Cite Score (R=0.39; p=0.001). The association between the H index of the Web of Science andthe H index of Scopus with the H index of SciELO was weak in both cases (R=0.45; p<0.001 and R=0.340; p=0.003). CONCLUSIONS: Indicators proposed by SciELO, for health journals, did not show an association with those of WoS or Scopus. The weak correlation between Impact Factor and Cite Score with SciELO Impact Factor, converts the latter into a necessary "metrics" to assess journals excluded from the "mainstream" and fundamentally those from the Latin American region. The need of using the prestige indicators to fill in the impact indicators, has not been proven in this study.

OBJETIVO: La utilización de indicadores bibliométricos para medir la calidad de las revistas científicas es una práctica generalizada en todos los ámbitos de la ciencia. Las bases de datos WoS y Scopus siguen siendo las fuentes de referencia en la obtención de indicadores biblométricos. Han surgido otras como la red SciELO que ofrecen indicadores de la ciencia iberoamericana, escasamente recogida en WoS y Scopus. El objetivo de este trabajo fue analizar la asociación de los indicadores propuestos por SciELO para las revistas de ciencias de la salud, con los indicadores de impacto más utilizados y estudiar la complementariedad de los indicadores de prestigio existentes. METODOS: Estudio analítico correlacional entre los indicadores ofrecidos por SciELO con los indicadores de impacto y prestigio de Journal Citation Report, Scopus y Web of Science. Se estudiaron los resultados de la anualidad 2018 al ser la más actual de la que se disponían los datos completos. Se analizó la existencia de asociación entre las variables cualitativas mediante la prueba de la chi-cuadrado, y en las variables cuantitativas se realizó el análisis de la varianza (ANOVA) utilizando como prueba post hoc el método de Tukey. Para obtener la relación entre variables cuantitativas se usó el coeficiente de correlación de Pearson y para las variables ordinales el de Spearman. El nivel de significación utilizado en todos los contrastes de hipótesis fue α≤0,05. RESULTADOS: El Factor de Impacto de SciELO presentó débil correlación tanto con el del Journal Citation Report (R=0,36; p=0,003), como con el Cite Score de Scopus (R=0,39; p=0,001). La asociación entre los índices H de la Web of Science y de Scopus, con el índice H de SciELO fue débil en ambos casos(R=0,45; p<0,001 y R=0,340; p=0,003). CONCLUSIONES: Los indicadores propuestos por SciELO para las revistas de las ciencias de la salud no presentaron asociación con los de WoS o Scopus. La no relación entre el Factor de Impacto y el CiteScore con el Factor de Impacto de SciELO convierte a este último en una "metría" necesaria para valorar las revistas excluidas de la "corriente principal" y fundamentalmente las del área latinoamericana. No se ha demostrado necesidad de utilizar los indicadores de prestigio para cumplimentar a los de impacto.