[How is the compliance with the tobacco control law in hospitaty terraces?] / ¿Se cumple la ley de control del tabaquismo en las terrazas de hostelería?

OBJECTIVE: To describe tobacco consumption and the compliance with the law on hospitality terraces in Barcelona. METHOD: Cross-sectional study by observation in a sample of 120 hospitality terraces in Barcelona. 30-minute observations were made using a standardized record sheet. The study variables were number of people smoking, number of cigarettes smoked, cigarette butts, socioeconomic status of the neighborhood, time of observation, consumption regulation, number of chairs and number of persons. RESULTS: There were people smoking at the time of the observation in 97.5% of the terraces, with no differences according to socioeconomic level of the neighborhood or the regulation of the terrace. There was no compliance with the law in 100% of the terraces where smoking was banned. CONCLUSIONS: The widespread non-compliance with the current law indicates the need to implement a smoking ban without exceptions on hospitality terraces.

Community action for health in socioeconomically deprived neighbourhoods in Barcelona: Evaluating its effects on health and social class health inequalities.

BACKGROUND: The aim of this study was to analyse trends in several health-related indicators in socioeconomically deprived neighbourhoods in Barcelona with strong community action for health (CA), and compare them to neighbourhoods without such community action. A secondary goal was to analyse trends in socioeconomic inequalities in health in both types of neighbourhood. METHODS: We performed a quasi-experimental pre-post study using data from the Barcelona Health Surveys of 2001 and 2011. Our dependent variables were self-perceived health, mental health, previous drug use, and smoking cessation. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% Confidence Intervals (95% CI). RESULTS: The percentage of men who had ever used drugs decreased over time in neighbourhoods with strong CA (PR = 0.48; 95% CI:0.25-0.92, from 2001 to 2011), but not in neighbourhoods without CA (PR = 1.02; 95% CI:0.74-1.40). However, the prevalence of poor mental health among men increased more in neighbourhoods with strong CA than in neighbourhoods without CA (p-value = 0.025). Among women, social class inequalities in poor mental health and smoking cessation decreased over time in neighbourhoods with strong CA but not in neighbourhoods without CA. CONCLUSIONS: Our study shows promising results regarding the effect of community action on health, particularly in terms of inequalities. Our results highlight the importance of allocating resources to implement and continuously evaluate CA initiatives.

Engagement, resilience and empathy in nursing assistants. / Engagement (compromiso), resiliencia y empatía en auxiliares de enfermería.

OBJECTIVE: To analyse the levels of engagement, resilience and empathy, and the relationship between them, in a sample of nursing assistants working in different private institutions in Huelva. METHOD: A transversal, descriptive study. The sample comprised 128 nursing assistants working in private health centres of Huelva. They were given the following instruments: resilience scale Wagnild and Young, Interpersonal Reactivity Index and Utrech Work Engagement Scale. CONCLUSIONS: There is a relationship between the cognitive and emotional components of engagement and empathy. Certain sociodemographic variables associated with the organisation of work and working conditions are associated with level of engagement.

Impact of using artemisinin-based combination therapy (ACT) in the treatment of uncomplicated malaria from Plasmodium falciparum in a non-endemic zone.

BACKGROUND: Artemisinin-based combination therapy (ACT) has been adopted by the World Health Organization as a first-line treatment for uncomplicated Plasmodium falciparum malaria. In endemic regions, it has proven more effective in treating the disease, and even in reducing its transmission. Nonetheless, there is a scarcity of studies carried out in non-endemic areas on imported uncomplicated malaria. METHODS: This is a retrospective, observational study performed on patients diagnosed and admitted with uncomplicated P. falciparum malaria between 2004 and 2015. The objective was to compare the parasite clearance period and the average hospital length of stay for patients treated with ACT vs those receiving other treatment regimens. RESULTS: Eighty-five patients were included in the study. Fifty-one received ACT treatment (dihydroartemisinin-piperaquine) and thirty-four patients were treated with quinine sulfate+doxycycline or atovaquone/proguanil. The parasite clearance period was shorter in the group of patients treated with ACT compared to those receiving other treatment types: 24 h (IQR 24) vs 48 h (IQR 48), p < 0.01. The average hospital stay was also shorter in the ACT group with respect to the second group: 2.67 days (IQR 1.08) vs 3.96 days (IQR 2.87), p < 0.001. A mild case of hepatitis was registered in the group treated with ACT. CONCLUSIONS: ACT treatment of admitted hospital patients with imported uncomplicated malaria from P. falciparum reduced the days spent hospitalized as well as producing a more rapid parasite clearance compared to classic treatment. In spite of being treated with safe medications, one has to be alert to possible adverse effects such as hepatitis and delayed haemolytic anaemia.

Epidemiological investigation of a foodborne outbreak in Spain associated with U.S. West Coast genotypes of Vibrio parahaemolyticus.

We describe an outbreak of seafood-associated Vibrio parahaemolyticus in Galicia, Spain in on 18th of August 2012 affecting 100 of the 114 passengers travelling on a food banquet cruise boat. Epidemiological information from 65 people was available from follow-on interviews, of which 51 cases showed symptoms of illness. The food items identified through the questionnaires as the most probable source of the infections was shrimp. This product was unique in showing a statistically significant and the highest OR with a value of 7.59 (1.52-37.71). All the nine strains isolated from stool samples were identified as V. parahaemolyticus, seven were positive for both virulence markers tdh and trh, a single strain was positive for trh only and the remaining strain tested negative for both trh and tdh. This is the largest foodborne Vibrio outbreak reported in Europe linked to domestically processed seafood. Moreover, this is the first instance of strains possessing both tdh+ and trh+ being implicated in an outbreak in Europe and that a combination of strains represent several pathogenicity groups and belonging to different genetic variants were isolated from a single outbreak. Clinical isolates were associated with a novel genetic variant of V. parahaemolyticus never detected before in Europe. Further analyses demonstrated that the outbreak isolates showed indistinguishable genetic profiles with hyper-virulent strains from the Pacific Northwest, USA, suggesting a recent transcontinental spread of these strains.

[Evaluation of a community program to reduce isolation in older people due to architectural barriers]. / Evaluación de un programa comunitario para reducir el aislamiento de personas mayores debido a barreras arquitectónicas.

OBJECTIVE: Social isolation impairs health. An intervention to reduce isolation due to architectural barriers in elderly persons was carried out in Barcelona (Spain). This study aimed to evaluate its effects on health. METHODS: We conducted a quasi-experimental before-after study. Isolated older people were identified in three deprived urban areas from 2009 to 2011. Participants had twice-weekly outings with volunteers in a stair-climbing power wheelchair. User satisfaction was evaluated and perceived health status, quality of life, and mental health before and after four outings were compared with McNemar tests. RESULTS: There were 74 participants (median age: 83 years; IQR: 78-89). Perceived health improved by 21%, mental health by 24%, and psychological distress was reduced by 16%. Most participants (98%) were satisfied. CONCLUSION: The intervention improved perceived health and mental health. Elderly people with impaired mobility should not live in buildings with architectural barriers and, if this cannot be avoided, similar programs should be implemented.

Certificación y Recertificación de Especialistas en Psiquiatría de Adultos: Una mirada desde CONACEM / Certification and recertification of specialists in Adult Psychiatry: Aview from CONACEM

Since 1984, 12.265 different medical specialists have been certified in Chile by the Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM). The certification in Psychiatry specialty was initiated in 1984 reaching504 candidates approved until December 2013. Three ways are available to achieve certification: a) to be approved by a reputable university program in the specialization; this way has been used by 42% of postulants; b) to fulfill the requirements of a 5 years practical training program, as 50% of postulants did; c) to have passed a training program abroad, similar to those in force in Chile (8%). There are 9, three-year-long reputable university programs with a total annual capacity of 46 students; almost half of it is for programs developed in provinces. With the exception of doctors completing reputable university programs, others postulants are require to pass a five days practical examination. Since 2002 a written test has been added, which must be taken and approved as a condition of the practical examination. Written examinations have demonstrated good discriminative capacity (82% average approval in 12 years). Extended certifications currently have a 10 years duration for the first time and 7 years for subsequent recertification. Revocation of certification involves installing a recertification mechanism. The reasons that support the recertification are analyzed, and also present the requirements to obtaining it. Current legislation requires that certification and recertification are done by accrediting entities. CONACEM has been legally recognized by de Ministery of Health since February 2014 as the unique entity to perform that labor.

Desde 1984 la Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM) ha certificado 12.665 especialistas médicos en Chile. La disciplina de Psiquiatría inició su certificación en 1986, habiendo certificado hasta diciembre de 2013 a 504 especialistas. Para la certificación existen tres vías posibles: a) haber aprobado un Programa de Formación Universitario Acreditado, lo que hizo el 42% de los postulantes; b) cumplir los requisitos de Adiestramiento en Práctica durante 5 años, como sucedió con el 50% de los postulantes; c) haber sido formado en el extranjero de acuerdo a programas convalidados. Existen 9 programas universitarios acreditados, de 3 años de duración, con un cupo total anual de 46 alumnos que se desarrollan en Santiago (n: 5) y Provincias (n: 4). Salvo los médicos aprobados en los Programas Universitarios acreditados, el resto de los postulantes requirió aprobar un examen práctico, y desde 2002, además, un examen escrito, como requisito para dar el práctico, y que ha resultado tener buena discriminación (18% de rechazo promedio en el período de 12 años). Las certificaciones dadas hoy, tienen una duración de 10 años al inicio y serán de 7 años en la recertificación. La caducidad de las certificaciones está aparejada al proceso de recertificación, de lo cual se discuten las razones que lo avalan; se presentan los requisitos y una tabla de créditos a cumplir, elaboradas por CONACEM. La legislación vigente y en proceso, requiere la actuación de al menos una entidad certificadora, condición que ha sido otorgada legalmente en forma única por el Ministerio de Salud a CONACEM a partir del 11/02/2014.

Certificación y recertificación de especialistas en anestesiología: una mirada desde CONACEM / Certification and recertification specialist anesthesiology: a look from CONACEM

Desde 1984 la Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM) ha certificado 12.294 especialistas médicos en Chile. La disciplina de Anestesiología inició su certificación en 1985, habiendo reconocido hasta diciembre de 2012 a 716 especialistas. Para la certificación existen tres vías posibles: a) haber aprobado un Programa de Formación Universitario Acreditado, lo que hizo el 53 por ciento de los postulantes; b) cumplir los requisitos de Adiestramiento en Práctica durante 5 años, lo que hizo un 41 por ciento de los postulantes. c) haber sido formado en el extranjero de acuerdo a programas convalidados. Existen 7 programas universitarios acreditados, de 3 años de duración, con un cupo total anual de 39 alumnos que se desarrollan en Santiago y provincias. Salvo los médicos aprobados en los Programas Universitarios acreditados, el resto de los postulantes requieren dar un examen práctico; desde 2002 se ha agregado un examen escrito, cuya aprobación es requisito para dar el práctico, y que ha resultado tener buena discriminación (49 por ciento de rechazo promedio en el período de 11 años de existencia). Las certificaciones dadas hoy, tienen una duración de 10 años al inicio y serán de 7 años en la recertificación. La caducidad de las certificaciones está aparejada al proceso de recertificación, de lo cual se discuten las razones que lo avalan; se presentan los requisitos y tabla de créditos a cumplir, elaborada por CONACEM. La legislación vigente y en proceso, requiere la actuación de al menos una entidad certificadora, condición que ha sido otorgada legalmente en forma única por el Ministerio de Salud a CONACEM a partir del 11/02/2014...

Since 1984, 12.294 different medical specialists have been certified in Chile by the Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM). The certification in Anestesiology specialty was initiated in 1985 reaching 716 candidates approved until December 2012. Three ways are available to achieve certification: a) to be approved by a reputable university program in the specialization; this way has been used by 53 percent of postulants; b) to fulfill the requirements of a 5 years practical training program, as 41 percent of postulants did; c) to have passed a training program abroad, similar to those in force in Chile (< 5 percent). There are 7, three-year-long reputable university programs with a total annual capacity of 39 students; half of it is for programs developed in provinces. With the exception of doctors completing reputable university programs, others postulants are require to pass a five days practical examination. Since 2002 a written test has been added, which must be taken and approved as a condition of the practical examination. Written examinations have demonstrated good discriminative capacity (52 percent average approval in 11 years). Extended certifications currently have a 10 years duration for the first time and 7 years for subsequent recertification. Revocation of certification involves installing a recertification mechanism. The reasons that support the recertification are analyzed, and also present the requirements to obtaining it. Current legislation requires that certification and recertification are done by accrediting entities. CONACEM has been legally recognized by de Ministery of Health since February 2014 as the unique entity to perform that labor...

Certificación y recertificación de especialistas en cirugía general: una mirada desde CONACEM / Certification of surgery specialists in Chile by the autonomous corporation for certification of medical specialties

Since 1984, 12.294 different medical specialists have been certified in Chile by the Autonomous Corporation for Certification of Medical Specialties (whose Spanish acronym is CONACEM). General Surgery certification started in 1984, approving 1.088 candidates thus far. Certification can be obtained in three ways. Seventy-two percent of applicants were approved by a reputable university specialization program. Twenty-three percent of applicants fulfilled the requirements of a five years practical training program and 5 percent were approved in a training program from another country which was validated in Chile. There are 13 university training programs for surgery specialty, lasting three years each. These programs can receive a total of 223 students per year. Thirty-one percent of these programs are not carried out in Santiago. Applicants, who have not completed a certified university training program, must go through a five days practical examination. Since 2002 a written test was added, whose approval is a requisite to gain access to the practical examination. Eighty-nine percent of applicants have approved the theoretical test. Certifications last 10 years initially and seven years, thereafter. When certifications expire, a recertification mechanism is required, whose requirements are informed. According to the current legislation, certifications must be done by recognized accrediting agencies. CONACEM has been accepted by the authority and its definitive legal recognition should be a reality soon...

Desde 1984 la Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM) ha certificado 12.294 especialistas médicos en Chile. La disciplina de Cirugía General inició su certificación en 1984, habiendo reconocido hasta la fecha a 1.088 especialistas. Para la certificación existen tres vías posibles: a) haber aprobado un Programa de Formación Universitario Acreditado, lo que hizo el 72 por ciento de los postulantes; b) cumplir los requisitos de Adiestramiento en Práctica durante 5 años, lo que hizo un 23 por ciento de los postulantes. c) haber sido formado en el extranjero de acuerdo a programas convalidados. Existen 13 programas universitarios acreditados de 3 años de duración, con un cupo total anual de 223 alumnos, de los cuales el 69 por ciento se desarrolla en Santiago y el resto en provincias. Salvo los médicos aprobados en los Programas Universitarios acreditados, los postulantes requieren dar un examen práctico; desde 2002 se ha agregado un examen escrito, cuya aprobación es requisito para dar el práctico, y que ha resultado tener buena discriminación (11 por ciento de rechazo en el período de 11 años de existencia). Las certificaciones dadas hoy, tienen una duración de 10 años al inicio y de 7 años posteriormente. La caducidad de las certificaciones está aparejada al proceso de recertificación, para lo cual se discuten las razones que lo avalan; se presentan los requisitos y tabla de créditos a cumplir, elaboradas por CONACEM. La legislación vigente y en proceso, requiere el reconocimiento de entidades certificadoras, concurso en el cual ha sido aceptado CONACEM, esperando la sanción legal definitiva...

[Certification of internal medicine specialists in Chile by the autonomous corporation for certification of medical specialties]. / Certificación y recertificación de especialistas en Medicina Interna: una mirada desde CONACEM.

Since 1984, 12.294 different medical specialists have been certified in Chile by the Autonomous Corporation for Certification of Medical Specialties (whose Spanish acronym is CONACEM). Infernal Medicine certification started in 1985, approving 1364 candidates thus far. Certification can be obtained in three ways. Sixty one percent of applicants were approved by a reputable university specialization program. Thirty five percent of applicants fulfilled the requirements of a five years practical training program and less than 5% were approved in a training program from another country which was validated in Chile. There are 13 university training programs for medical specialties, lasting three years each. These programs can receive a total of 110 students per year. Half of these programs are not carried out in Santiago. Applicants, who have not completed a certified university training program, must go through a five days practical examination. Since 2002 a written test was added, whose approval is a requisite to gain access to the practical examination. Sixty one percent of applicants have approved the theoretical test. Certifications last 10 years initially and seven years, there after. When certifications expire, a recertification mechanism is required, whose requirements are informed. According to the current legislation, certifications must be done by recognized accrediting agencies. CONACEM has been accepted by the authority and its definitive legal recognition should be a reality soon.

Impact of incident comorbidity on functional loss in elderly chronic kidney disease patients undergoing hemodialysis.

The incidence of end stage renal disease in older persons has been increasing progressively over the last 10 years. Improved survival rates with renal replacement therapy are making this increased prevalence even more pronounced. The usual risks of morbidity and requirements for specialized care associated with older people increase dramatically when they have chronic kidney disease (CKD). It has been seen that the majority of patients in hemodialysis units are over the age of 60, and have significant co-morbidities. The relationship between older age, chronic disorders and functional dependence (FD) is well known. Accordingly, nursing care planning must be designed with this in mind. The aim of this study was to assess whether the comorbidity associated with CKD modifies FD in patients on hemodialysis. We undertook a prospective longitudinal cohort study of hemodialysis outpatients in Málaga, Spain, using the Barthel test to establish FD and the Charlson comorbidity index to quantify comorbidity. All health events were analyzed to select those study patients with incident comorbidity, understood as the appearance of a new disease that could modify the Charlson comorbidity index, and determine the change in FD. Multivariate linear regression showed that the best model for predicting functional loss was that which considered comorbidity adjusted for age, particularly when it occurred as a result of hospital admission, as it was shown to have an important predictive value for the onset of a decrease in functional dependency scores in patients with CKD.

Miocardiopatía tirotóxica grave: consideraciones a propósito de un caso clínico / Severe thyrotoxic myocardiopathy: report of one case

We report a previously healthy 43 years old male, that one year ago presented with a hyperthyroidism, treated with metimazole and radioiodine. Two months after receiving the latter, he was admitted to the hospital for dyspnea, tachycardia and chest pain. An atrial fibrillation with a frequency of 190 beats per minute was found. During hospital stay, the patient suffered a cardiogenic shock that recovered. The patient was discharged five days after admission. During follow up, there was a progressive reduction of cardiac symptoms.

[Assessment of the surgical site infection in 14 hospitals of the Madrid Region: an incidence study]. / Evaluación de la infección de herida quirúrgica en 14 hospitales de la Comunidad de Madrid: estudio de incidencia.

BACKGROUND AND OBJECTIVES: Health care-associated infections (HAIs) occur frequently in hospitals and have severe consequences, with surgical site infection (SSI) being one of the most commonly reported. The aim of this study was to determine SSI rates and to asses the application of presurgical preparation and antimicrobial prophylaxis protocols in 14 public hospitals of the region of Madrid. MATERIAL AND METHODS: Multi-centre prospective surveillance study. All patients who underwent a surgical procedure from January 1 2009, to December 31, 2009 with a hospital stay of more than 48 hours, were monitored from the time of surgery until hospital discharge. RESULTS: SSI was the most frequent HAI (superficial incisional SSI=1.7%; deep incisional SSI=2%; organ-space SSI=1.7%). SSI rates are provided by operative procedure and NNIS risk index category. Further quality indicators reported are surgical complications, length of stay, antimicrobial prophylaxis, mortality, readmission due to infection or other complications and revision surgery. CONCLUSIONS: The results obtained in this multicentre study can be used as a reference for other public hospitals, and allow comparisons with other international surveillance systems. Surveillance and control of HAIs must be a key aspect in patient safety and quality healthcare programs.