Cancer-related fatigue and its determinants in a cohort of women with breast cancer: the DAMA Cohort.

Cancer-related fatigue (CRF) is one of the most prolonged discomforts suffered by people who have had cancer. Seventy-eight to ninety-six percent of cancer patients experience fatigue, especially while undergoing treatment. CRF is related to insomnia, anxiety, depression, and also varies depending on age. However, little is known about the factors contributing to CRF and better understanding of determinants of CRF makes it easier to identify early patients at risk and in designing intervention planning. The aim of this study was to assess the influence of precipitating factors (diagnosis of breast cancer and other clinical aspects) and perpetuating factors (social network, quality of life, mental disorders) on the presence of chronic fatigue in women from our cultural context, by social class each other determinants. METHODS: It was carried out a mixed cohort study (prospective and retrospective) using a convenience sample of women diagnosed with breast cancer. The information sources were data from the Brief Fatigue Inventory questionnaire and hospital medical records. The dependent variable was fatigue and the independent variables were age, social class, time since diagnoses, cohabitation, comorbidity, relapse, body mass index, mental health (anxiety and depression), social network, social support, and quality of life. RESULTS: Seventy-two percent of the women in the DAMA cohort reported moderate to severe fatigue. Risk of suffering from severe fatigue was greatest among individuals with low social class, those aged under 50 years, those with chronic disorders who had relapsed, and those with symptoms of anxiety and depression. In our study, CRF did not appear to be related to the stage of the cancer at diagnosis, or to the time since diagnosis. CONCLUSIONS: CRF is an element that the professionals responsible for the control and monitoring of women should take into account as another element to be taken into consideration.

Frequency of outpatient care adverse events in an occupational mutual insurance company in Spain.

BACKGROUND: Occupational mutual insurance companies (OMICs), in collaboration with the Spanish Social Security System, provide healthcare and manage the economic benefits for the workers in Spain. They have ambulatory care centers that attend outpatient trauma pathology, although most of the studies published have focused on surgical and hospital activity. The aim of this study was to detect adverse events (AEs) in outpatient trauma care in the context of an OMIC. METHODS: A cohort study designed to identify harmful safety incidents (adverse events, AEs) in 2017 was conducted. A random sample of 313 medical records among patients who were visited more than 3 medical and nursing attendances during their outpatient process. The AEs detected were classified according to category, severity and preventability. RESULTS: We identified 48 AEs (15.3% of medical records, 95% CI 11.3-19.3), most of them procedure-related, while 27 (56.2%) were preventable and 46 mild (95.8%). CONCLUSIONS: The AEs identified are double than those found in primary care general consultations in Spain and are close to the lower range of studies on surgical AEs in traumatology and orthopedics. Preventable AEs were within expected limits. Over half of AEs are preventable, within that group, the mild AEs have an increased rate of preventability. These results highlight the relevance of research of patient safety in the outpatient care of trauma and orthopaedic procedures in an OMIC for patient safety and contribute to introduce improvements in outpatient care.

Anxiety and depression in women with breast cancer: Social and clinical determinants and influence of the social network and social support (DAMA cohort).

BACKGROUND: Anxiety and depression are the most prevalent mental health pathologies among women with breast cancer. Social, clinical and contextual variables may influence emotional stress among women with breast cancer. The aim of this work is to study anxiety and depression in a cohort of women diagnosed with breast cancer between 2003 and 2013 in Barcelona. We evaluate social and clinical determinants. METHODS: We performed a mixed cohort study (prospective and retrospective) using a convenience sample of women diagnosed with breast cancer. The information sources were the Hospital Anxiety and Depression questionnaire and hospital medical records. Dependent variables were anxiety and depression; independent variables were social class, age, employment status, tumour stage at diagnosis, time since diagnosis, social network and social support. We performed a descriptive analysis, a bivariate analysis, and a multivariate logistic regression analysis. RESULTS: A total of 1086 (48.6%) women had some degree of anxiety-related problem. As for depression. In the case of depression, 225 (15%) women had some degree of depression-related problem. Low emotional support and social isolation were clear risk factors for having more anxiety and depression. Low social class was also a risk factor, and age also played a role. DISCUSSION: Our results show that women long period of cancer survival have high prevalences of anxiety than depression, and this prevalence of anxiety is higher than the general population. In addition, we found inequalities between social classes and the isolation and social support are worse too in low social class.

[Implementation of good quality and safety practices. Descriptive study in a occupational mutual health centre]. / Implantación de buenas prácticas en calidad y seguridad. Estudio descriptivo en una mutua laboral.

OBJECTIVE: To describe the level of implementation of quality and safety good practice elements in a Mutual Society health centre. METHOD: A Cross-sectional study was conducted to assess the level of implementation of good practices using a questionnaire. Some quality dimensions were also assessed (scale 0 to 10) by a set of 87 quality coordinators of health centres and a random sample of 54 healthcare professionals working in small centres. RESULTS: Seventy quality coordinators and 27 professionals replied (response rates 80% and 50%, respectively. There were no differences in the assessment of quality attributes between both groups. They identified as areas for improvement: use of practice guidelines (7.6/10), scientific and technical skills (7.5/10), and patient satisfaction (7.7/10). Availability and accessibility to clinical reports, informed consent, availability of hydro-alcoholic solution, and to record allergies, were considered of high importance to be implemented, with training and research, improvements in equipment and technology plans, adherence to clinical practice guidelines and the preparation of risk maps, being of less importance. CONCLUSION: The good practices related to equipment and resources have a higher likelihood to be implemented, meanwhile those related to quality and safety attitudes have more barriers before being implemented. The mutual has a similar behaviour than other healthcare institutions.

Epidemic soybean asthma and public health: new control systems and initial evaluation in Barcelona, 1996-98.

OBJECTIVE: To evaluate the new measures adopted to control the risks from soybean unloading operations in the Port of Barcelona, after an episode of epidemic asthma in June 1996. METHODS: After an initial cautionary suspension of all soybean unloading operations, they were subsequently resumed under restrictive criteria for time, flux, simultaneity, and meteorological conditions. Emission filtration systems based on either micro pore size filters or polytetrafluoroethylene membranes on tetratex filters showed promising results. RESULTS: Allergen emission underwent a very important decrease to levels 95% to 98% lower. Emissions from the two plants with unloading operations are in the same order of magnitude as the processing plant that does not unload soybean. Allergen concentration levels presented fluctuations initially, but the new filters decreased mean values; despite increased unloading, allergen levels did not increase-mean allergen levels on unloading days (67 U/m(3)) and on days without unloading operations (63 U/m(3)) are similar. A panel of patients detected a cluster of increased symptoms during unloading operations on a day with suboptimal meteorological conditions and comparatively low allergen levels (225-415 U/m(3)). Since the June 1996 episode, no further asthma outbreak has been detected. CONCLUSIONS: The evaluation shows the effectiveness of the new filters in the control of soybean dust emission. With a systematic control programme, industrial soybean operations may function near urban centres without public health risks. These data may be useful in the development of future standards for allergenic agents.

[Profile of the hospital case mix of the immigrant population in Barcelona, Spain]. / Perfil de la casuística hospitalaria de la población inmigrante en Barcelona.

OBJECTIVE: Although the immigrant population in cities such as Barcelona has tripled in the last five years, until now the impact of this group on the health system has not been rigorously evaluated. The aim of this study was to compare hospital resource utilization among the immigrant population with that among the native population through case mix, demographic characteristics and hospital day use. MATERIAL AMD METHODS: We analyzed 15,057 discharges from Hospital del Mar in Barcelona in 2000. This hospital attends 60% of admissions from the Ciutat Vella district. In 2000, 21% of the population of this district were immigrants. Socio-demographic patient characteristics and case mix were compared between the immigrant and the native population. Hospital resource use was compared according to age, case mix (diagnosis related groups) and seriousness (severity, complications and comorbidities) of the events requiring medical care. RESULTS: The case mix of the immigrant population differed from that of the autochthonous population due to pronounced ge differences and a higher fertility rate. Thirty-three percent of immigrant admissions were for deliveries. The mean cost of discharge of immigrants from low-income countries was 30% lower than that for the remaining discharges. After adjusting for age, case mix and severity, length of stay among the immigrant population was significantly shorter. A 5% reduction was found after adjusting for case mix and a 10% reduction was found when all the factors were considered. CONCLUSIONS: Case mix differences are due to age and socio-cultural factors. Immigrants are rejuvenating the ageing native population and the role of gynecology-obstetrics and pediatrics needs to be increased. The finding that resource use per discharge is lower among immigrants from low-income countries contradicts the expectation that lower socioeconomic status leads to higher hospital resource use intensity. Therefore, new hypotheses and analyses that explain this situation should be put forward.

[Coping with the toll of heroin: 10 years of the Barcelona Action Plan on Drugs, Spain]. / Afrontar los estragos de la heroína: evaluación de diez años de un programa integral en Barcelona.

INTRODUCTION: The epidemic of heroin use began in Barcelona, as in the rest of Spain, in the late 70's, to reach its peak by the end of the 80's. In a first period, responsible officers experimented difficulties to define the specific objectives of opiate control policies. This paper reviews the effects of the adoption of an explicit policy on drug dependence grounded on a wide consensus in the City of Barcelona (Catalonia, Spain). SUBJECTS AND METHODS: Over a period of twelve years, from 1986 to 1997, both demand and offer of care and harm reduction services were analyzed, as well as the evolution of the adverse effects of drug use, such as mortality from acute adverse drug reaction, human immunodeficiency virus (HIV) infection, aids incidence, and incidence of tuberculosis. Data for city residents was compared through four different stages in this period. RESULTS: Despite the lack of data in initial years, relevant changes are apparent. Treatment offer changes clearly, with significant increases in initial treatment, coverage of methadone maintenance programmes, and sterile syringes distribution. Therapeutic compliance of tuberculous intravenous drug users IVDU and risk of HIV infection improve. Emergency service use linked to heroin, overdose, or withdrawal syndrome decreases. Mortality rates decline, although this decline does not reach statistical significance. DISCUSSION: Service offer shows a clear increase, reflected in treatment initiation, while harm reduction services expand. With the development of this process, outcome indicators change, both reflecting changes in the toll of the heroin epidemic (cases of tuberculosis and aids among IVDUs, HIV infection). and changes in a more comprehensive care (better treatment compliance of IVDUs with tuberculosis). There is a lower distortion of emergency services. These changes occur although the predominance of white heroin in Barcelona favors parenteral use.

Implantación de buenas prácticas en calidad y seguridad. Estudio descriptivo en una mutua laboral / Implementation of good quality and safety practices. Descriptive study in a occupational mutual health centre

Objetivo. Describir el nivel de implantación de elementos de buena atención sanitaria en una mutua. Método. Estudio descriptivo, transversal. Se encuestó al conjunto de 87 referentes de calidad de MC Mutual y una submuestra aleatoria de 54 sanitarios con destino en centros con entre 4 y 7 profesionales sanitarios. Los 23 elementos del cuestionario fueron seleccionados por su condición de ser identificados como buenas prácticas. Adicionalmente, los sujetos valoraron una serie de atributos que describían el nivel de calidad de los centros (escala de 0 a 10). Resultados. Respondieron 70 referentes y 27 profesionales (tasa respuesta del 80% y 50%, respectivamente). Entre ambos colectivos no hubo diferencias en la valoración de los atributos de calidad. Identificaron como áreas de mejora: uso de guías de práctica (7,6/10), competencia científico-técnica (7,5/10) y satisfacción de los pacientes (7,7/10). Consideraron con alta implantación: disponibilidad y accesibilidad a la historia clínica común, consentimiento informado, disponibilidad de solución hidroalcohólica y sistema de registro de alergias. Con baja implantación: formación e investigación, planes de mejoras en equipamientos y tecnología, adhesión a guías de práctica clínica y mapas de riesgos. Conclusión. Mientras se logra un alto nivel de implantación en elementos de buena práctica relacionados con equipamientos y recursos, otros aspectos relacionados con actitudes hacia la calidad y seguridad requieren de mayor atención, como sucede en otras organizaciones sanitarias (AU)

Objective. To describe the level of implementation of quality and safety good practice elements in a Mutual Society health centre. Method. A Cross-sectional study was conducted to assess the level of implementation of good practices using a questionnaire. Some quality dimensions were also assessed (scale 0 to 10) by a set of 87 quality coordinators of health centres and a random sample of 54 healthcare professionals working in small centres. Results. Seventy quality coordinators and 27 professionals replied (response rates 80% and 50%, respectively. There were no differences in the assessment of quality attributes between both groups. They identified as areas for improvement: use of practice guidelines (7.6/10), scientific and technical skills (7.5/10), and patient satisfaction (7.7/10). Availability and accessibility to clinical reports, informed consent, availability of hydro-alcoholic solution, and to record allergies, were considered of high importance to be implemented, with training and research, improvements in equipment and technology plans, adherence to clinical practice guidelines and the preparation of risk maps, being of less importance. Conclusion. The good practices related to equipment and resources have a higher likelihood to be implemented, meanwhile those related to quality and safety attitudes have more barriers before being implemented. The mutual has a similar behaviour than other healthcare institutions (AU)

[Comparison of primary care teams in Barcelona according to management formulas]. / Comparación de equipos de atención primaria de Barcelona según formulas de gestión.

OBJECTIVE: The aim of the study is to compare, among socio-economically similar areas, the use of medical services, clinical practice and pharmacy costs depending on the how the primary healthcare teams, that provide these services, are organized according to different managemental formulas. DESIGN: Descriptive study of the evaluation of health care services. PATIENTS AND METHODS: The population units (basic health areas) attended by the reformed primary health care services in Barcelona were classified into three levels according to the population's socioeconomic status (high, medium or low). For each level, two primary health care teams were selected representing different primary health care providers: "Institut Catala de la Salut"; and others. The influence of both the provision option and the population characteristics on service use, clinical practice and costs of prescription were compared. MAIN RESULTS: The services offered by the two provision options differ. However, the use of medical services is related to the socioeconomic characteristics and not to the option for service provision. Whilst there are no relevant differences in clinical practice between the different options, we observed variations among different primary care teams, notably in referrals to specialists and influenza vaccine coverage. The greater source of variation in prescription costs seems to be related to an external confounding factor. CONCLUSIONS: Empirical data have not identified relevant differences in the pattern of use, clinical practice, or costs between the different options for service provision within the model of reformed primary care services. Observed variations seem to be associated mainly with the population's characteristics, its pattern of health service use or other external confounding factors.

Perfil de la casuística hospitalaria de la población inmigrante en Barcelona / Profile of the hospital case mix of the immigrant population in Barcelona, Spain

Objetivo: A pesar de que en los últimos 5 años la población inmigrante se ha triplicado en ciudades como Barcelona, hasta el momento no se ha evaluado de forma rigurosa el impacto de este colectivo en el sistema sanitario. El objetivo del presente estudio ha sido comparar el perfil de la hospitalización de la población inmigrante con la autóctona, desde el punto de vista de la casuística, gravedad, características demográficas y consumo de estancias. Material y métodos: Se han analizado las 15.057 altas del Hospital del Mar de Barcelona en el año 2000. Este hospital asiste el 60 por ciento de los ingresos hospitalarios del distrito de Ciutat Vella, distrito que presentaba en el año 2000 un porcentaje de inmigrantes residentes del 21 por ciento. Se han comparado las características sociodemográficas y de casuística de los pacientes en razón de ser o no inmigrantes. También se ha comparado el consumo de recursos hospitalarios teniendo en cuenta la edad, la casuística (grupos relacionados por el diagnóstico) y la gravedad (severidad, complicaciones y comorbilidades) de la patología atendida. Resultados: La población inmigrante ha presentado una casuística distinta de la autóctona por la marcada diferencia en la edad y por su mayor tasa de fecundidad. El 33 por ciento de los ingresos de inmigrantes han sido partos. El coste medio de las altas de inmigrantes de países de renta baja valorado en consumo de estancias hospitalarias, ha sido un 30 por ciento menor que el del resto de las altas. Una vez ajustadas la edad, la casuística y la severidad, el consumo de estancias hospitalarias en la población inmigrante ha sido significativamente menor. La diferencia se ha cifrado en un 5 por ciento cuando sólo se ha ajustado por patología y en un 10 por ciento cuando han sido considerados todos los factores. Conclusiones: Las diferencias en la casuística vienen marcadas por la edad y por las diferencias socioculturales. La pirámide de edad de la población hospitalaria inmigrante recompone la envejecida estructura de edad de los pacientes autóctonos y plantea la necesidad de recuperar el mayor peso de los servicios de ginecología-obstetricia y pediatría. El hecho de que exista menor consumo de recursos por alta hospitalaria en la población inmigrante de países de renta baja contradice la relación esperada de inmigrante-peor situación socioeconómica-mayor intensidad de consumo de recursos por alta hospitalaria. Deben proponerse nuevas hipótesis de trabajo y análisis que permitan explicar esta realidad (AU)

Objective: Although the immigrant population in cities such as Barcelona has tripled in the last five years, until now the impact of this group on the health system has not been rigorously evaluated. The aim of this study was to compare hospital resource utilization among the immigrant population with that among the native population through case mix, demographic characteristics and hospital day use. Material and methods: We analyzed 15,057 discharges from Hospital del Mar in Barcelona in 2000. This hospital attends 60% of admissions from the Ciutat Vella district. In 2000, 21% of the population of this district were immigrants. Socio-demographic patient characteristics and case mix were compared between the immigrant and the native population. Hospital resource use was compared according to age, case mix (diagnosis related groups) and seriousness (severity, complications and comorbidities) of the events requiring medical care. Results: The case mix of the immigrant population differed from that of the autochthonous population due to pronounced ge differences and a higher fertility rate. Thirty-three percent of immigrant admissions were for deliveries. The mean cost of discharge of immigrants from low-income countries was 30% lower than that for the remaining discharges. After adjusting for age, case mix and severity, length of stay among the immigrant population was significantly shorter. A 5% reduction was found after adjusting for case mix and a 10% reduction was found when all the factors were considered. Conclusions: Case mix differences are due to age and socio-cultural factors. Immigrants are rejuvenating the ageing native population and the role of gynecology-obstetrics and pediatrics needs to be increased. The finding that resource use per discharge is lower among immigrants from low-income countries contradicts the expectation that lower socioeconomic status leads to higher hospital resource use intensity. Therefore, new hypotheses and analyses that explain this situation should be put forward (AU)

Comparar centros y proveedores de atención primaria

Emprender comparaciones rigurosas de los servicios de atención primaria es una necesidad creciente en nuestro país. En los últimos años han surgido propuestas orientadas a un modelo más pluralista de provisión de los servicios de financiación pública, abierto a diversos proveedores. Poder comparar de qué forma estos diversos proveedores desempeñan su misión asistencial y los logros que alcanzan será clave tanto para el futuro del sistema como para sustentar políticas sanitarias basadas en la evidencia. En este trabajo se revisan algunas cuestiones relevantes para tales comparaciones desde la perspectiva del denominado modelo reformado de atención primaria de nuestro sistema de financiación pública. Las comparaciones de profesionales, equipos y proveedores plantean aspectos metodológicos relevantes, que también se suscitan respecto a la estructura de los servicios, el proceso asistencial y su resultado, y el uso de servicios. Se revisan los factores de confusión ligados a la población y a los servicios, así como a la unidad de análisis (AU)

Música y drogas en la movida del fin de semana / Music and drugs in the weekend

O consumo de drogas, tanto legais como ilegais, é universal. De acordo com os diversos estudos de prevalência e incidência há diferentes padrões de consumo entre os países, levando em consideração o gênero, sendo mais elevado no sexo masculino do que no feminino. Entretanto, ambos os sexos se equiparam quanto ao início. É importante coletar e analisar os casos atendidos nos serviços de urgência hospitalar, que demostra muitos deles como consumidores e múltiplas drogas e abusadores de estimulantes. O serviço de controle de consumo de novas drogas entre os jovens de Barcelona, constata que o consumo entre os jovens é fundamentalmente recreacional, descontínuo e variável. O consumo de drogas, tempo livre e socialização são variáveis intimamente ligadas ao rito de passagem da adolescência à juventude. Está bem examinado o consumir e o "estar drogado". Preocupa o alto número de acidentes de trânsito em jovens que consumiram álcool. È necessária uma mudança de atitude dos profissionais e dos pais, para prevenir a estigmatização de consumista e para facilitar o processo de comunicação entre adultos jovens

Afrontar los estragos de la heroína: evaluación de diez años de un programa integral en Barcelona / Coping with the toll of heroin: ten years of the Barcelona Action Plan on Drugs, Spain

Introducción: La epidemia de consumo de heroína se inició en Barcelona, como en el conjunto de España, a finales de los años 70, para alcanzar probablemente su máxima expresión a finales de los 80. En una primera etapa los responsables del problema apreciaron dificultades para llegar a una definición clara de objetivos, aunque posteriormente se alcanzó un consenso amplio que permitió la formulación de planes de acción con objetivos explícitos. Este trabajo revisa los efectos de la adopción de una política explícita y consensuada hacia las drogodependencias por el Ayuntamiento de Barcelona. Sujetos y métodos: Se analiza la oferta y utilización de servicios asistenciales y de limitación de daños, y la evolución de las complicaciones asociadas al consumo, como son la mortalidad por reacción adversa aguda, la incidencia de la infección por el virus de la inmunodeficiencia humana (VIH) y del sida, y la incidencia de enfermedad tuberculosa a lo largo de 12 años, entre 1986 y 1997. Se compara la situación en cuatro momentos a lo largo del período. El estudio se restringe a los residentes en la ciudad. Resultados: Pese a las lagunas de información existentes en los períodos iniciales, se aprecian cambios relevantes. La oferta de tratamiento se modifica de forma clara, con incrementos significativos de los inicios de tratamiento, la tasa de usuarios cubiertos por programas de mantenimiento con metadona, y en la media de jeringas estériles distribuidas. Mejoran tanto el cumplimiento terapéutico de los usuarios de drogas por vía parenteral (UDVP) con tuberculosis como su riesgo de infección por el VIH. Respecto a los servicios de urgencia, disminuye su uso asociado a la heroína, por sobredosis, o por síndrome de abstinencia. La tasa de mortalidad por sobredosis disminuye desde el tercer trienio, aunque sin alcanzar diferencias estadísticamente significativas. Discusión: Los datos de oferta asistencial, reflejados en los inicios de tratamiento y los diversos servicios de reducción de riesgos, muestran un claro incremento de la oferta, con un cambio de perfil. Por otra parte, con el desarrollo de esta respuesta asistencial se modifican tanto los indicadores que muestran los estragos de la epidemia de opiáceos en complicaciones infecciosas (casos de tuberculosis y sida en UDVP e infección por VIH), como los que reflejan un abordaje asistencial más integral (mejor cumplimiento terapéutico de los UDVPs con tuberculosis). Se aprecia también una menor sobrecarga disfuncional de los dispositivos asistenciales de urgencias. Estos cambios se producen pese a que Barcelona se ve marcada por el predominio de heroína blanca, que favorece la vía parenteral (AU)