[Impact of primary care nursing discharge follow-up on early hospital readmissions. Observational longitudinal study]. / Impacto del seguimiento al alta de Enfermería en Atención Primaria sobre los reingresos hospitalarios tempranos. Estudio observacional longitudinal.

AIM: To determine the proportion of people who undergo discharge follow-up when indicated. DESIGN: Retrospective longitudinal observational study, with an analytical approach. POPULATION: persons discharged from the Hospital Universitario de la Princesa of any age and sex, with any reason for admission and with an indication for discharge follow-up in Primary Care. Users who did not have an assigned Autonomous Personal Identification Code (CIPA) were excluded. Random sample (n=289). VARIABLES: Discharge follow-up and readmissions (<30 days). Sociodemographic, clinical and discharge follow-up variables were included from the electronic medical records of Primary and Hospital Care. A descriptive analysis of the sociodemographic and clinical characteristics of the study population was conducted. To analyze the association between discharge follow-up and readmissions, a logistic regression model was used. RESULTS: Age 72.4 years (RIQ 60-87). 55.2% of the population were women. Follow-up was conducted in 61.2% of those indicated. According to the logistic regression model performed between early readmission and discharge follow-up, adjusted for all other factors, the group with discharge follow-up had a 66% lower likelihood of hospital readmission (OR 0.34, 95% CI (0.18-0.67)). CONCLUSIONS: These findings suggest that nursing discharge follow-up conducted in primary care reduces the risk of early readmission.

Utilization of Healthcare Services in Patients with Chronic Diseases under 18 Years Old: Differences and Contributing Factors.

Pediatric patients with chronic conditions frequently have unmet care needs, make extensive use of healthcare services, and often encounter fragmented, non-centered care. This study aimed to analyze the differences in the utilization of primary care (PC) and hospital care (HC) services by these patients according to sex, age, and complexity and to identify associated factors. A cross-sectional study was conducted in a basic health area of Madrid, including patients under 18 years. Among these patients, 15.7% had ≥1 chronic disease, 54.1% were male, the average age was 9.5 years, 3.5% had complexity, and 11.3% had multimorbidity. The mean number of contacts/year with the healthcare system was 9.1, including 8.3 contacts/year with PC (4.9 with pediatricians and 1.9 with nurses) and 0.8 contacts/year with HC (0.8 in external consultations and 0.01 hospitalizations). The factors associated with PC utilization were complexity; female sex; European origin; and diseases like asthma, epilepsy, stroke, recurrent urinary infection, attention deficit hyperactivity disorder, and anxiety, while older age was negatively associated. Thyroid disorders were significantly associated with HC utilization. These findings could help guide the design of optimized pediatric patient-centered care approaches to coordinate care across healthcare services and reduce high healthcare utilization, therefore improving the healthcare outcomes and quality of life for these patients.

Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol.

Aims: To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain. Design: Multicentric, mixed method concurrent study. Methods: This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022). Discussion: The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic. Trial Registration: Identifier: NCT05249868 [ClinicalTrials.gov].

Family Caregivers' Experiences during the COVID-19 Pandemic: Qualitative Study.

Background: The COVID-19 pandemic imposed lockdown measures that affected caregiving. Understanding caregivers' context provides reveals their adaptive strategies to continue caring in this situation of uncertainty and isolation. Objective: To better understand the caregiving experiences of caregivers looking after dependent individuals living in the community during the pandemic. Design: Qualitative research, phenomenological approach. Setting: Primary healthcare centers in Madrid region (Spain). Participants: 21 family caregivers. Methods: Purposive and theoretical sampling was used to recruit caregivers across nurses from primary healthcare centers. Participants were interviewed using a semi-structured interview guide to explore the caring experience. Interview transcripts were evaluated using thematic analysis. Results: The findings were categorized into two themes: "Caregivers during lockdown-providing care in a time of adversity" and "Caregiving toward normality". The sub-themes identified were the re-structuring of before-care services and the introduction of new care approaches, managing the dependent person's health problems, looking after oneself, and dealing with adversity. To adapt to the new normal, strategies were put in place designed to recover confidence and trust, reincorporate assistance, and reconnect with others. Conclusions: Care intensified during the pandemic. Caregivers took on the task without assistance, focusing on preventing contagion and protecting themselves to be able to continue giving care.

Assessment of dyspneic sensation in patients with type 2 diabetes.

Introduction: Individuals with type 2 diabetes (T2D) should be considered a susceptible group for pulmonary dysfunction. So, we aimed to evaluate the sensation of breathlessness in this population by administering two well-validated questionnaires. Methods: This is a crosssectional study with 592 people without known respiratory disease (353 with T2D) who answered the modified Medical Research Council (mMRC) questionnaire. In addition, 47% also responded to the St George Respiratory Questionnaire, a specific instrument designed to be applied to patients with obstructive airway disease. Results: Patients with T2D showed a higher mMRC score in comparison to the control group [1.0 (0.0 - 4.0) vs. 0.0 (0.0 - 4.0), p<0.001]. A higher prevalence of subjects with mMRC ≥2 was observed in T2D that in the control group (20.2% vs. 11.6%, p=0.004). Participants with T2D and mMRC ≥2 showed a higher HbA1c (8.2 ± 1.6% vs. 7.8 ± 1.6%, p=0.048), longer T2D evolution and higher prevalence of nephropathy. In the multivariate analysis, the presence of T2D [OR=1.95 (1.19 to 3.22), p=0.008] in all the population, and HbA1c [OR=1.19 (1.01 to 1.41), p=0.034] and the presence of diabetic nephropathy [OR=2.00 (1.14 to 3.52), p=0.015] in patients with T2D, predicted a mMRC ≥2. Finally, no differences were observed regarding the SGRQ score among groups. Conclusions: Patients with T2D showed a greater sensation of dyspnea than subjects with normal carbohydrate metabolism. Risk factors included poor metabolic control and the presence of renal disease.

Health-related quality of life in caregivers of community-dwelling individuals with disabilities or chronic conditions. A gender-differentiated analysis in a cross-sectional study.

BACKGROUND: Most care for people with chronic or disabling conditions living in the community is provided in the family context, and this care is traditionally provided by women. Providing informal care has a negative impact on caregivers' quality of life, which adds to existing health inequalities associated with gender. The aim of this study was to analyze factors associated with the health-related quality of life of caregivers and to determine their differences in a gender-differentiated analysis. METHODS: An observational, cross-sectional, multicenter study was conducted in primary healthcare. A total of 218 caregivers aged 65 years or older were included, all of whom assumed the primary responsibility for caring for people with disabling conditions for at least 6 months per year and agreed to participate in the CuidaCare study. The dependent variable was health-related quality of life, assessed with the EQ-5D. The explanatory variables tested were grouped into sociodemographic variables, subjective burden, caregiving role, social support and variables related to the dependent person. The associations between these variables and health-related quality of life were estimated by fitting robust linear regression models. Separate analyses were conducted for women and men. RESULTS: A total of 72.8% of the sample were women, and 27.2% were men. The mean score on the EQ-5D for female caregivers was 0.64 (0.31); for male caregivers, it was 0.79 (0.23). There were differences by gender in the frequency of reported problems in the dimensions of pain/comfort and anxiety/depression. The variables that were associated with quality of life also differed. Having a positive depression screening was negatively associated with quality of life for both genders: -0.31 points (95% CI: -0.47; -0.15) for female caregivers and -0.48 points (95% CI: -0.92; -0.03) for male caregivers. Perceived burden was associated with quality of life in the adjusted model for women (-0.12 points; 95% CI: -0.19; -0.06), and domestic help was associated in the adjusted model for male caregivers (-0.12 points; 95% CI: -0.19; -0.05). CONCLUSIONS: Gender differences are present in informal caregiving. The impact of providing informal care is different for male and female caregivers, and so are the factors that affect their perceived quality of life. It could be useful it incorporates a gender perspective in the design of nursing support interventions for caregivers to individualize care and improve the quality of life of caregivers. TRIAL REGISTRATION: NCT01478295 [ https://ClinicalTrials.gov ]. 23/11/2011.

The Slow Component of Oxygen Uptake and Efficiency in Resistance Exercises: A Comparison With Endurance Exercises.

INTRODUCTION: There is a lack of information regarding the slow component of oxygen uptake (VO2sc) and efficiency/economy in resistance exercises despite the crucial role played in endurance performance. PURPOSE: this study aimed to compare the VO2sc, efficiency/economy, metabolic, cardiorespiratory responses, rating of perceived effort and mechanical fatigue between cycling and half-squat (HS) exercises during a constant-load test at lactate threshold (LT1) intensity. METHODS: Twenty-one healthy men were randomly assigned in a crossover design to perform cycle-ergometer or HS tests. The order of the two cycle ergometer tests was an incremental test for determining load-intensity in watts (W) at LT1, followed by a constant-load test at the LT1 intensity. For the three HS tests, the order was a 1RM test to determine the load (kg) corresponding to the 1RM percentages to be used during the second test, incremental HS exercise to establish the load (kg) at the LT1 intensity, and finally, a constant-load HS test at the LT1 intensity. A rest period of 48 h between each test was established. During the HS and cycle-ergometer constant-load tests, cardiorespiratory and metabolic responses were recorded. Lower limbs fatigue was determined by a jump test before and after the constant-load tests. RESULTS: A significant exercise mode × time interaction effect was detected in VO2, heart rate, energy expenditure (EE), gross efficiency (GE), and economy (p < 0.05). A significant and sustained VO2 raise was confirmed in HS exercise (p < 0.05) and a steady-state VO2 was revealed in cycle-ergometer. A higher GE and economy were obtained in HS test than in cycle-ergometer exercise (p < 0.001). In both exercises, a non-significant decrease was observed in GE and economy (p > 0.05). Lower limbs fatigue was only detected after constant-load HS test. CONCLUSION: Although the VO2, heart rate and EE responses were higher in cycling exercise, the constant-load HS test induced a greater VO2sc and EE raise than the cycling test in a predominantly aerobic metabolism. These results could explain a decrease observed in jump performance only after HS test. GE and economy could benefit from the eccentric phase of the HS exercise.

INGUINAL REPAIR VIA ROBOTIC ASSISTED TECHNIQUE: LITERATURE REVIEW.

INTRODUCTION: Inguinal hernia is one of the most frequent surgical diseases. Currently, with the advantages of minimally invasive surgery, new questions arise: what will be the best approach for correction of inguinal hernia? Is there real benefit to the robotic approach? OBJECTIVE: To compile results of the published studies that used the robot-assisted technique in the repair of inguinal hernia, analyzing its limitations, complications and comparing it with those of the pre-existing techniques. METHOD: The review was performed from the Medline database with the following descriptors: (inguinal hernia repair OR hernioplasty OR hernia) AND (robot OR robotic OR robotic assisted) being retrieved 391 articles. After verification of the titles and abstracts, we identified eight series of cases congruent with the objectives of this review. Three reviewers participated in the extraction and selection of results. RESULTS: Comparative studies showed an increase in surgical time in relation to the open and videolaparoscopic approach. The complications present similar rates with the other repair routes. CONCLUSION: This technique has been shown to be effective for the correction of inguinal hernia, but the benefits of using robotic surgery are unclear. So, there is a need for randomized studies comparing laparoscopic to robotic repair.

Exercise Prescription Using the Borg Rating of Perceived Exertion to Improve Fitness.

The present study aimed to compare two fitness-training methodologies, instability circuit resistance training (ICRT) versus traditional circuit resistance training (TCRT), applying an experimental model of exercise prescription controlling and modulating exercise load using the Borg rating of perceived exertion. Forty-four healthy young adults age (21.6±2.3 years) were randomly assigned to three groups: TCRT (n=14), ICRT (n=14) and a control group (n=16). Strength and cardiorespiratory tests were chosen to evaluate cardiorespiratory and muscular fitness before and after the training program. In cardiorespiratory data, a significant difference was observed for the time effect in VO2max, peak heart rate, peak velocity, and heart rate at anaerobic threshold intensity (p<0.05) in the experimental groups. In strength variables, a significant Group x Time interaction effect was detected in 1RM, in mean propulsive power, and in peak power (p≤0.01) in the back squat exercise. In the bench press exercise, a significant time effect was detected in 1RM, in mean propulsive power, and in peak power, and a Group x Time interaction in peak power (all p<0.05). We can conclude that applying an experimental model of exercise prescription using RPE improved cardiorespiratory and muscular fitness in healthy young adults in both experimental groups.

Inguinal repair via robotic assisted technique: literature review / Reparo inguinal via técnica robótico-assistida: revisão da literatura

ABSTRACT Introduction: Inguinal hernia is one of the most frequent surgical diseases. Currently, with the advantages of minimally invasive surgery, new questions arise: what will be the best approach for correction of inguinal hernia? Is there real benefit to the robotic approach? Objective: To compile results of the published studies that used the robot-assisted technique in the repair of inguinal hernia, analyzing its limitations, complications and comparing it with those of the pre-existing techniques. Method: The review was performed from the Medline database with the following descriptors: (inguinal hernia repair OR hernioplasty OR hernia) AND (robot OR robotic OR robotic assisted) being retrieved 391 articles. After verification of the titles and abstracts, we identified eight series of cases congruent with the objectives of this review. Three reviewers participated in the extraction and selection of results. Results: Comparative studies showed an increase in surgical time in relation to the open and videolaparoscopic approach. The complications present similar rates with the other repair routes. Conclusion: This technique has been shown to be effective for the correction of inguinal hernia, but the benefits of using robotic surgery are unclear. So, there is a need for randomized studies comparing laparoscopic to robotic repair

RESUMO Introdução: A hérnia inguinal é uma das doenças cirúrgicas mais frequentes. Atualmente, com as vantagens da cirurgia minimamente invasiva, novas questões surgem: qual será a melhor abordagem para correção de hérnia inguinal? Existe benefício real com a abordagem robótica? Objetivo: Compilar resultados dos estudos publicados que utilizaram a técnica robô-assistida no reparo da hérnia inguinal analisando suas limitações, complicações e comparando-a com as das técnicas pré-existentes. Método: A revisão foi realizada a partir da base de dados do Medline com os seguintes descritores: (inguinal hernia repair OR hernioplasty OR hernia) AND (robot OR robotic OR robotic assisted) sendo recuperados 391 artigos. Após verificação dos títulos e resumos, identificou-se oito séries de casos congruentes com os objetivos desta revisão. Três revisores participaram do processo de extração e seleção de resultados. Resultados: Nos estudos comparativos demonstrou-se aumento no tempo cirúrgico em relação à via aberta e videolaparoscópica. As complicações apresentam taxas similares com as outras vias de reparo. Conclusão: Esta técnica demonstrou-se efetiva para correção da hérnia inguinal, mas os benefícios da utilização da cirurgia robótica não estão claros. Para isso, há a necessidade de trabalhos randomizados que comparem o reparo laparoscópico ao robotizado.