[Abordaje y atención a la cronicidad con tecnologías digitales en las políticas sanitarias en España]. / Approach and attention to chronicity with digital technologies in health policies in Spain.

OBJECTIVE: From the healthcare policies that support Public Health strategies, technology implementation in healthcare is an innovative element to address chronicity. Its introduction is not uniform across Spain, despite of the existence of digital strategic implementation and national chronicity plans. The aim of this paper was to explore the current deployment of autonomic strategies for chronicity and the implementation of digital tools for telemonitoring and user support. METHODS: A descriptive cross-sectional study was conducted through documental review of autonomous strategies in digital health and chronicity care, available until 2020. Consequently, a consultation was carried out to eighteen experts addressing autonomic availability, benefits and barriers to healthcare digitalization. RESULTS: The expert consultation revealed that, in fifteen autonomous communities, the use and the enhancement of digital technologies were addressed and in nine the focus was on promoting digital transformation. Eleven communities are working on updates, fourteen have health-related digital applications, thirteen allow users checking their test results, ten allow them to carry out administrative procedures, nine deliver patient support resources, and three provide telematic communication channels. 38.89% of the consulted refered not knowing about the existence of any follow-up and monitoring programs in their community. The 60% identified a gap in digital competencies among citizens and the lack of resources, as main barriers to implementation. CONCLUSIONS: There exists disparity in the update of strategies to address chronicity and the introduction of digital technologies. Many of them are currently updating, which is an opportunity to provide efficient responses that incorporate digital tools.

OBJECTIVE: La implementación de tecnologías digitales supone un elemento innovador para el abordaje de la cronicidad, como parte de las estrategias de Salud Pública. Su implantación es variable a nivel autonómico, pese a existir un plan nacional. Este trabajo pretendió conocer el despliegue de las estrategias autonómicas sobre cronicidad, así como de la implementación de opciones de telemonitorización y apoyo al usuario. METHODS: Se realizó un estudio descriptivo transversal mediante revisión documental de las estrategias autonómicas de salud digital y abordaje de la cronicidad disponibles hasta 2020. Se realizó una posterior consulta a dieciocho personas expertas sobre disponibilidad autonómica, beneficios y barreras a la digitalización de la atención sanitaria. RESULTS: La consulta a personas expertas reveló que quince comunidades autónomas abordaron el uso y la potenciación de tecnologías digitales y nueve trabajaron en favorecer la trasformación digital. Once comunidades trabajan en actualizaciones, catorce tienen aplicaciones digitales de salud, trece permiten a los ciudadanos consultar resultados de pruebas, diez permiten trámites administrativos, nueve ofrecen recursos de apoyo al paciente y tres disponen de canales telemáticos de comunicación. El 38,89% de los consultados refirió no conocer los programas de seguimiento y monitorización en su comunidad. El 60% identificó a la falta de competencias digitales de la ciudadanía y a la falta de recursos como barreras de su implantación. CONCLUSIONS: Existe disparidad en la actualización de estrategias para el abordaje de la cronicidad y la implantación de tecnologías digitales. Muchas de ellas se están actualizando, lo que supone una oportunidad para dar respuestas eficientes que incorporen las herramientas digitales.

Effectiveness of motor imagery in complex regional pain syndrome: A systematic review with meta-analysis.

OBJECTIVE: The purpose of this study was to determine the effects of motor imagery (MI) on pain intensity and disability in individuals with complex regional pain syndrome (CRPS). METHODS: A systematic search was conducted in various electronic databases to identify all relevant studies: PubMed, CINAHL, WOS, PEDro, CENTRAL, and Scopus. Randomized controlled trials assessing the effects of MI in individuals with CRPS were included. The risk of bias was assessed with the Cochrane Risk of Bias tool, the methodological quality was evaluated using PEDro scale, and the level of evidence was reported according to the GRADE. Between-groups standardized mean differences (SMD) were calculated. RESULTS: Six studies were included. The meta-analysis found moderate-quality evidence that MI improves pain intensity and related disability as immediate (pain: SMD -1.07, 95% CI: -1.53 to -0.60; disability: SMD 1.05, 95% CI: 0.59 to 1.51), short-term (pain: SMD -1.28, 95% CI: -2.14 to -0.42; disability: SMD 1.37; 95% CI: 0.16 to 2.58), and long-term effects (pain: SMD -1.18; 95% CI: -1.89 to -0.46; disability: SMD 1.18; 95% CI: 0.46 to 1.89), as compared with a comparison group. The risk of bias of the trials was relatively low, but the imprecision of the results downgraded the level of evidence. CONCLUSIONS: Moderate-quality evidence suggests a positive effect of MI for improving pain intensity and disability immediately after and at short-term in individuals with CRPS.

Evaluation of the use of a nursing diagnosis Risk for Falls in the Community of Madrid (Spain) Primary Care System.

PURPOSE: The purpose of this study was to describe the use of the nursing diagnosis Risk for Falls in Primary Care System of the Community of Madrid. METHODS: A retrospective review of the clinical histories was carried out in 262 health centers from January 2005 to December 2015. The study population are the patients who have recorded in their electronic health record the nursing diagnosis Risk for Falls. FINDINGS: Frequency of use of the Risk for Falls ND in the Community of Madrid was 53,340 diagnoses, increasing from 650 nursing diagnosis in 2005 to 14,695 in 2015. NOC Nursing Outcomes total identified were 109,145, which represents an average of 2.05 NOC Nursing Outcomes per diagnosis. NOC Nursing Outcomes frequently appeared as follows: Fall Prevention Behavior (35.9%), Safe Home Environment (11.3%), and Risk Control (10.5%). NIC Nursing Interventions total identified were 104,293, representing an average of 1.96 NIC nursing interventions per diagnosis. NIC Nursing Interventions frequently appeared as follows: Fall Prevention (45.9%), Environmental Management: Safety (27%), and Risk Identification (5.8%). CONCLUSIONS: Nursing diagnosis of Risk for Falls and the care process related to this diagnosis is starting to be used by the primary care nurses of the Community of Madrid. IMPLICATION FOR NURSING PRACTICE: Risk factors related to the nursing diagnosis of risk for falls identified in our study can be addressed with activities that nurses must implement to prevent falls. Nursing methodology in general and specifically the diagnosis of risk for falls must be included in guides and protocols for the prevention of falls, and its use should be promoted by primary care nurses.

'Learning by doing', a model for improving the promotion of healthy lifestyles by student nurses.

BACKGROUND: 'Learning by doing' is a learning model based on performing actions and gaining experience. The 'nursing process' is a systematic, rational method for providing nursing care. During their university education, nursing students need to acquire the ability to promote healthy lifestyles. OBJECTIVE: To determine the effectiveness of a learning strategy based on learning by doing and grounded in the use of the nursing process, on the lifestyle of nursing students. METHODS: This quasi-experimental intervention (before-after), performed over 2011-2022, involved 2300 nursing students at a university nursing school in Spain. The risk factors for chronic diseases-being a smoker, being overweight, or having high blood pressure-to which each student was exposed were recorded. Those positive for at least one risk factor selected companion students as 'support nursing students' who became responsible for designing an individualised care plan to reduce the risk(s) faced. To ensure the correct use of the nursing process, teachers approved and monitored the implementation of the care plans. Whether risk-reduction objectives were met was determined three months later. RESULTS: The students with risk factors largely improved their lifestyles (targets for reducing smoking/body weight were met) with the help of their supporting peers. CONCLUSIONS: The learning by doing method demonstrated its effectiveness, improving the lifestyle of at-risk students via the use of the nursing process.

Flu Vaccination Coverage and Predictors of Non-Vaccination in Military Health Corps Personnel 2016-2017 and 2019-2021.

(1) Background: Vaccination is the most effective intervention to control seasonal influenza morbidity and mortality. The present study aimed to determine the influenza vaccination coverage in the Military Health Corps personnel in the 2020−2021 season, as well as the time trend and the possible influence of the pandemic on coverage, in order to study the reasons that led to the non-vaccination of health professionals and to analyze adverse drug reactions (ADRs). (2) Methods: A descriptive, cross-sectional study was conducted from February to May 2021. All FAS CMS personnel were included. A self-administered questionnaire was sent by e-mail to the selected personnel. (3) Results: Vaccination coverage in the 2016−2017 season was 15.8% (n = 276), in the 2019−2020 season it was 17.41% (n = 424), and in the 2020−2021 season it was 24.22% (n = 590). The percentage of vaccinated men was higher than the percentage of women. In 2019 and 2020 the most vaccinated group was 31−40 years old. Lieutenants had the highest vaccination uptake in 2019 and 2020. The personnel with the highest uptake of vaccines were those in the specialty of nursing in each of 2016, 2019 and 2020, with >30 years of time worked in 2016. In terms of factors leading to refusal of vaccination, the most reported was "not considered a risk group" (23.0%), and the least reported was "avoidance of vaccine administration" (2.2%). Eighty individuals presented adverse reactions after vaccine administration (9.6%). (4) Conclusions: The rate of influenza vaccination among healthcare professionals was lower during the 2020 season compared to the previous season, but was expected to increase in the upcoming 2021 season.

Vaccine Coverage against Influenza and SARS-CoV-2 in Health Sciences Students during COVID-19 Pandemic in Spain.

Vaccination against influenza and SARS-CoV-2 is recommended in health sciences students to reduce the risk of acquiring these diseases and transmitting them to patients. The aim of the study was to evaluate how the pandemic influenced the modification of influenza vaccination coverage during the 2019/2020 and 2021/2022 campaigns and to analyze the vaccination coverage against SARS-CoV-2 in health sciences students. A cross-sectional study was conducted among students of the Faculty of Nursing, Physiotherapy and Podiatry of the Complutense University of Madrid. A questionnaire was administered in two stages, the first, Q1, before the start of the pandemic, where we analyzed influenza coverage during the 2019/2020 campaign and a second, Q2, 18 months after the start of the pandemic where we analyzed influenza coverage during the 2021/2022 campaign and coverage against SARS-CoV-2. A total of 1894 students (58.78% of the total of those enrolled) participated. Flu vaccination coverage increased from 26.7% in Q1 to 35.0% in Q2 (p < 0.05), being higher in the age group older than 21 years, who studied nursing, were in their fourth year and lived with people at risk. Vaccination coverage against SARS-CoV-2 was very high (97.8%), especially in students vaccinated against influenza. Coverage of the influenza vaccine in health sciences students increased from 2019-2020 to 2021-2022, being higher in the age group older than 21 years, who studied nursing, were in their first and fourth year and lived with people at risk. Coverage of the SARS-CoV-2 vaccine in health sciences students was very high, especially in those vaccinated against influenza.

The Attitude towards Vaccination of Health Sciences Students at a Spanish University Improved over the First 18 Months of the COVID-19 Pandemic.

It is important to know the attitudes of students of health sciences (SHSs) towards vaccination since they will be tomorrow's health professionals. Vaccination is a powerful tool in the fight against COVID-19. The aim of the present, cross-sectional study was to examine how the COVID-19 pandemic has influenced the attitude of SHSs towards vaccination. Data were collected in the form of a questionnaire from all students of nursing, physiotherapy and chiropody matriculated at a Madrid University for the academic year 2019/2020 (i.e., before the start of the pandemic [Q1]), and from all those matriculated for the year 2021/22 (i.e., c18 months after the pandemic was declared [Q2]). A multivariate analysis was performed to identify the influence of sex, degree being studied, course year and the time of answering (Q1 or Q2), on the dimensions Beliefs, Behaviours and General Attitude. Overall, 1894 questionnaires were returned (934 [49.3%] for Q1, and 960 [50.7%] for Q2), of which 70.5% were completed by students of nursing, 14% by students of physiotherapy and 15.4% by those studying chiropody. In Q2, the results for all three dimensions were significantly better (p < 0.05). The most important influencing factors were being a student of nursing, being in the final years of training (years 3 or 4), female gender and answering at the time of Q2. The results obtained are encouraging since student nurses (who showed Q1 and Q2 General Attitude scores of 3.34 and 3.47 (maximum possible 4), respectively [p < 0.05]) are the health professionals of tomorrow most likely to be involved in vaccination programmes.

[Prevalence of sarcopenia in older age hospitalized persons, as determined by different sets of diagnostic criteria.] / Prevalencia de sarcopenia determinada por diferentes criterios diagnósticos en ancianos hospitalizados.

OBJECTIVE: Sarcopenia is a geriatric syndrome characterised by the progressive loss of skeletal muscle mass, muscular strength, and physical performance; it carries the risk of physical incapacity and reduced quality of life. This work reported the prevalence of sarcopenia in people aged ≥65 years, all in-patients at the Hospital Central de la Defensa Gómez Ulla, as determined by three sets of diagnostic criteria. The suitability of the indistinct use of these criteria sets was discussed. METHODS: This was a cross sectional study. Sarcopenia was diagnosed depending on muscle mass, strength and functionality according to the European Working Group on Sarcopenia in Older People (EWGSOP), EWSOP2 and SARCF criteria. This study involved 295 people, all aged ≥65 years, and all of whom had been admitted to the above hospital between 1st March and 30th September 2018. Sampling was consecutive and performed at the internal medicine ward. RESULTS: The overall prevalence of sarcopenia was 43.7% [95%CI 38-49.4%] according to the EWGSOP criteria, 28.5% [23.3-33.7%] according to EWGSOP2, and 37.6% [32-43.1%] according to SARCF. The EWGSOP criteria showed sarcopenia to be significantly more common among men than women (p<0.05). CONCLUSIONS: The prevalence of sarcopenia recorded differed depending on the set of criteria used; they cannot, therefore, be used indistinctly for the diagnosis of this condition. Rather, given the results obtained, it would seem reasonable, in Europe, to continue using the EGSWOP criteria while research continues in this area.

OBJETIVO: La sarcopenia es un síndrome geriátrico caracterizado por la pérdida progresiva de masa muscular esquelética, disminución de fuerza y rendimiento físico. El objetivo de este estudio fue conocer la prevalencia de la sarcopenia en la población anciana mayor o igual a 65 años en el Hospital Central de la Defensa Gómez Ulla (Madrid), según tres criterios diagnósticos. METODOS: Se realizó un estudio transversal entre 295 personas con edad mayor o igual a 65 años a fecha de inicio del estudio, ingresados en el citado hospital entre el 1 de marzo y el 30 de septiembre de 2018. La sarcopenia se definió en función de la masa muscular, la fuerza muscular y la funcionalidad, de acuerdo al criterio EWGSOP, EWGSOP2 y SARC-F. Se compararon usando la prueba de McNemar y el Índice Kappa. RESULTADOS: La prevalencia de sarcopenia según el criterio EWGSOP fue del 43,7% (IC 95%; 38%-49,4%), según EWGSOP2 del 28,5% (23,3%-33,7%) y según el criterio SARC-F del 37,6% (32%-43,1%), siendo mayor en hombres que en mujeres con diferencia estadísticamente significativa (p<0,05). No se halló significación (p=0,116) para emplear de forma indistinta un criterio u otro. Se buscó relación entre los criterios EWGSOP y los ítems del cuestionario SARC-F, hallándose diferencias entre el número de caídas y la masa muscular, entre la fuerza muscular y el rendimiento físico, y entre el ítem levantar/llevar 0,5 kg y la fuerza muscular. CONCLUSIONES: La prevalencia de sarcopenia es diferente dependiendo del criterio de medida. No es posible intercambiar los criterios EWGSOP, EWGSOP2 y el cuestionario SARC-F para minimizar recursos.

Prevalence of childhood overweight/obesity in Spain 1993-2011 and associated risk factors in 2011 Prevalencia de sobrepeso y obesidad infa.

INTRODUCTION: Childhood obesity is a recognized public health problem. The present work reports the changing prevalence of childhood overweight/obesity in Spanish boys and girls over the period 1993-2011, and examines the risk factors apparent in 2011. METHODS: Children with a body mass index (BMI) of ≥ 25 were deemed overweight, and those with a BMI of ≥ 30 were deemed obese. Overweight and obesity was consistently more common among boys than among girls. RESULTS: The prevalence of overweight and obesity in Spain increased over the study period. CONCLUSIONS: According to the 2011 data, children who undertook no physical activity, or whose parents/guardians had a low level of education, showed the highest prevalence of obesity.

Differences in the prevalence of diagnosis of overweight-obesity in Spanish children according to the diagnostic criteria set used.

OBJECTIVE: To examine relevant differences in the prevalence of overweight and obesity in children aged 2-15 years according to different sets of criteria (Orbegozo Foundation, International Obesity Task Force and World Health Organization), and how their use affects the trends in obesity recorded for both sexes between 1995 and 2011 in Spain. METHOD: Cross-sectional study, a population between 2 and 15 years. Three diagnosis criteria of overweight and obesity were be used. RESULTS: The boys according to the three criteria, showed higher values of overweight and obesity compared to the girls. The lowest levels of overweight and obesity were observed using the Orbegozo tables. DISCUSSION: The prevalence of overweight and obesity varies significantly according to the criteria used to define overweight and obesity. The percentiles of the Foundation Orbegozo gave the lowest estimates and the standards of growth of the World Health Organization were higher.

Factores asociados al sobrepeso y la obesidad infantil en España, según la última encuesta nacional de salud (2011) / Factors associated with overweight and childhood obesity in Spain according to the latest national health survey (2011)

Objective: To describe the factors associated with overweight/obesity in Spain according to the latest National Health Survey (2011). Method: Descriptive cross-sectional study with 3,752 children aged 2 to 15 years (boys=2,007; girls=1,745). Main variables: overweight; obesity; gender; level of education of the head of the family; monthly income; hours of sleep; physical exercise; hours of TV and/or computer use; daily breakfast; parents' weight perception. Diagnostic criterion was based on WHO growth patterns, defined overweight with +1SD and obesity, +2SD. Results: Boys more obese than girls. Children whose parents had a lower level of education, those who did not practice physical activity and whose parents had an income of less than 900€ per month showed a higher percentage of overweight/obesity. Conclusions: Children whose parents had a lower education and monthly income presented a higher percentage of obesity. Sleeping the recommended hours and doing some type of physical activity reduces obesity.

Objetivo: Descrever os fatores associados com sobrepeso/obesidade na Espanha, segundo dados da última Pesquisa Nacional de Saúde (2011). Método: Estudo descritivo transversal com 3.752 crianças de 2 a 15 anos (meninos=2007; meninas=1.745). Principais variáveis: excesso de peso; obesidade; sexo; nível de escolaridade do chefe da família; renda mensal; horas de sono; exercício; horas de utilização da televisão e/ou computador; desjejum diário; percepção de obesidade dos pais. O diagnóstico baseou-se em padrões de crescimento da OMS, sendo o excesso de peso +1DP e a obesidade +2DP. Resultados: Meninos mais obesos que meninas. Crianças cujos pais tinham menos anos de estudo, aquelas que não praticam atividade física e cujos pais possuíam uma renda menor de 900 € mensal mostraram maior percentual de obesidade. Conclusão: Menor nível de escolaridade e baixa renda contribuem mais para a obesidade. Dormir as horas recomendadas e fazer algum tipo de atividade física reduz a obesidade.

Objetivo: Describir los factores asociados al sobrepeso/obesidad en España según datos de la última Encuesta Nacional de Salud (2011). Métodos: Estudio descriptivo transversal en población infantil de 2 a 15 años. Participaron 3752 individuos (niños n=2007 y niñas n=1745). Muestreo aleatorio polietápico estratificado. Principales variables: sobrepeso; obesidad; sexo; nivel de estudios del progenitor; ingresos mensuales; horas de sueño; ejercicio físico; horas de uso de televisión y/u ordenador; desayuno diario; percepción ponderal de los progenitores. Los criterios diagnósticos fueron los estándares de OMS, definiéndose sobrepeso con +1SD y obesidad, +2SD. Resultados: Niños más obesos que niñas. Niños/as cuyos progenitores presentaban un nivel de estudios bajo, niños/as que no hicieron ningún ejercicio y cuyos progenitores ganaron menos que 900€ mensuales presentaron un mayor sobrepeso/obesidad. Conclusión: Niños/as con progenitores con bajo nivel de estudios y de ingresos presentaron mayor obesidad. Dormir las horas recomendadas y hacer actividad física disminuye la obesidad.