Social Vulnerability and COVID-19 Vaccine in Spain.

Different analyses show that the design of vaccination policies should especially protect the most vulnerable social groups, since the level of acceptance is determined by the population's knowledge, attitude and concerns about the safety and efficacy of vaccines. The objective of this work will be to detect the most socially vulnerable groups with respect to COVID-19 and to analyze the factors that influence predisposition to vaccination. This is a cross-sectional study using data from the Centro de Investigaciones Sociológicas (CIS) on the Effects and Consequences of Coronavirus (Study 3346 of December 2021). Sociodemographic variables (sex, age, employment status, studies and subjective class identification) were extracted, as well as the answers to the questions indicating the attitude towards vaccination, corresponding to questions 7,8,10 and 11 of the study. The most vulnerable group was lower class women (self-perceived), under 45 years of age with lower educational level, unemployed or performing unpaid work in the home. Most of them are not predisposed to vaccinate only because of the obligation to do so, mainly due to lack of belief in the power and efficacy of vaccines, as well as fear of health risks/collateral side effects. The lower vaccine uptake in this vulnerable population group may be due to a lack of awareness and lower trust in the authorities, as well as the benefits of the vaccine, which could be related to a lack of policy targeting the most socially vulnerable populations.

Older Adults and Positive Mental Health during the Second and Sixth COVID-19 Waves in Spain.

The spread of the COVID-19 virus was a worldwide phenomenon, which was unprecedented in modern times. The restriction measures can be perceived as a heavy burden for mental health during this period, particularly for some groups. The aim of this study is to examine a positive mental health model across ages, where a moderated mediation model is proposed involving sex differences and confidence in coping with COVID-19. Two independent samples were studied during the second and sixth waves in Spain: n = 2861 and n = 2462, respectively. The main conclusions can be described as follows: (i) while age was not related to mental health during the second wave, a positive relationship was found between it and the sixth one; (ii) age was positively related to the confidence in coping with COVID-19 during both of the waves; (iii) women showed worse scores for the variables in the study than the men did during the second wave, but this pattern was reversed in the sixth one; (iv) after a moderated mediation model on the relationship between age and positive mental health in terms of confidence in coping with COVID-19 and sex, an interaction was found for the second wave but not for the sixth one. These results suggest that older adults and women would develop more strategies and resources for a positive mental health across time.

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort.

BACKGROUND: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults. METHODS: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition. RESULTS: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14-7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10-8.63, p = 0.032)). CONCLUSION: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative period.

Before-and-After Study of the First Four Years of the Enhanced Recovery after Surgery (ERAS®) Programme in Older Adults Undergoing Elective Colorectal Cancer Surgery.

BACKGROUND: The aim of this study was to determine whether the inclusion of older patients undergoing elective colorectal cancer resection in the Enhanced Recovery After Surgery (ERAS®) programme could improve clinical outcomes during hospital admission. METHODS: A before-and-after study in ≥70-year-old patients electively admitted for colorectal cancer resection was designed. In total, 213 patients were included in the ERAS® group, and 158 were included in the control group. RESULTS: The average age was 77.9 years old (SD 5.31) and 57.14% of them were men, with a Charlson Index score of 3.42 (SD 3.32). The ERAS® group presented a lower transfusion rate of 42 (19.7%), compared to 75 (47.5%) in the control group (p < 0.001). The crude odds ratio (OR) for transfusion was 0.27 (95% CI 0.17-0.43; p < 0.001), and the adjusted odds ratio was 0.26 (95% CI 0.14-0.48; p < 0.001). The ERAS® group had a lower percentage of patients with moderate-severe malnutrition on admission, at 23.4% (37 patients) against 36.2% in the control group (42 patients) (p = 0.023), with an OR of 0.47 (95% CI 0.29-0.75; p < 0.002) and an adjusted OR of 0.48 (95% CI 0.29-0.78; p = 0.003). The number of patients who required admission to the intensive care unit (ICU) was also markedly lower: 54 from the ERAS® group (25.4%) versus 71 from the control group (44.9%) (p < 0.001). CONCLUSIONS: The inclusion of ≥70-year-old adults in the ERAS® programme resulted in a decrease in transfusions, number of erythrocyte concentrates transfused, and number of ICU admissions, along with improved nutritional status.

Influence of hospital adverse events and previous diagnoses on hospital care cost of patients with hip fracture.

Previous diagnoses of patients with hip fracture influence the hospitalization cost of these patients, either directly or by increasing the risk of in-hospital adverse events associated with increased costs. PURPOSE: To investigate how previous diagnoses influence the occurrence of in-hospital adverse events and how both factors impact on hospital costs. METHODS: This is a retrospective analysis of the hospital Minimum Basic Data Set. Patients aged 70 years or older admitted for hip fracture (HF) at a single University Hospital between January 2012 and December 2016. Both, previous diagnoses and adverse events, were defined according to the International Classification of Diseases (ICD-9/ICD-10). The anticipated cost of each admission was calculated based on diagnosis-related groups and using the "all patients refined" method (APR-DRG). The occurrence of adverse events during hospital stay was assessed by excluding all diagnoses present on admission. RESULTS: The record included 1571 patients with a mean (SD) age of 84 years. The most frequent previous diagnoses were diabetes (n = 432, 27.5%) and dementia (n = 251, 16.0%), and the most frequent adverse events were delirium (n = 238, 15.1%) and anemia (n = 188, 12.0%). The mean (SD) total acute care costs per patient were €8752.1 (1864.4). The presence of heart failure, COPD, and kidney disease at admission significantly increased the hospitalization cost. In-hospital adverse events of delirium, cardiac events, anemia, urinary tract infection, and digestive events significantly increased costs. The multivariate analyses identified kidney disease as a previous diagnosis significantly contributing to explain an increase in hospitalization costs, and delirium, cardiac disease, anemia, urinary infection, respiratory event, and respiratory infection as in-hospital adverse events significantly contributing to an increase of hospitalization costs. CONCLUSIONS: Although few baseline comorbidities have a direct impact on hospitalization costs, most previous diagnoses increase the risk of in-hospital adverse events, which ultimately influence the hospitalization cost.

Estimate of the Costs Caused by Adverse Effects in Hospitalised Patients Due to Hip Fracture: Design of the Study and Preliminary Results.

INTRODUCTION: Hip fracture is a health problem that presents high morbidity and mortality, negatively influencing the patient's quality of life and generating high costs. Structured analysis of quality indicators can facilitate decision-making, cost minimization, and improvement of the quality of care. METHODS: We studied 1571 patients aged 70 years and over with the diagnosis of hip fracture at Hospital Universitario de la Ribera in the period between 1 January 2012 and 31 December 2016. Demographic, clinical, functional, and quality indicator variables were studied. An indirect analysis of the costs associated with adverse events arising during hospital admission was made. A tool based on the "Minimum Basic Data Set (CMBD)" was designed to monitor the influence of patient risk factors on the incidence of adverse effects (AE) and their associated costs. RESULTS: The average age of the patients analysed was 84.15 years (SD 6.28), with a length of stay of 8.01 days (SD 3.32), a mean preoperative stay of 43.04 h (SD 30.81), and a mortality rate of 4.2%. Likewise, the percentage of patients with AE was 41.44%, and 11.01% of patients changed their cost as a consequence of these AEs suffered during hospital admission. The average cost of patients was €8752 (SD: 1,864) and the average cost increase in patients with adverse events was €2321 (SD: 3,164). CONCLUSIONS: Through the analysis of the main clinical characteristics and the indirect estimation of the complexity of the patients, a simple calculation of the average cost of the attention and its adverse events can be designed in patients who are admitted due to hip fracture. Additionally, this tool can fit the welfare quality indicators by severity and cost.