[Factors associated with treatment adherence for tuberculosis infection]. / Factores asociados a la adherencia en el tratamiento de la infección tuberculosa.

OBJECTIVE: To analyze adherence to treatment of tuberculosis infection and to identify risk factors for its compliance. DESIGN: An observational historical cohort study. SETTING: Hospital Universitari Sant Joan d'Alacant (Alicante). PARTICIPANTS: All patients with a tuberculin skin test (TST) done during tuberculosis contact tracing during 6 years. RESULTS: We included 764 tuberculosis contacts in the analysis. 59.7% of the 566 patients who completed the contact tracing, had tuberculosis infection (TI). Of the patients with TI, 45.6% had not started treatment for tuberculosis infection (TTBI). Factors associated with not starting TTBI were: age (36-65 years, RR: 5.8; 95% CI: 1.2-27.5, and > 65 years, RR: 11.3; 95% CI: 2.0-64.0), the social relationship with TB case (RR: 2.2; 95% CI 1.2-3.8), and the TST reaction (≥ 15mm; RR: 0.5; 95% CI: 0.3-0.9). The completion rate for TTBI was 80.4% among people who started therapy. The treatment regimen was associated with greater compliance to TTBT (7-9H, RR: 12.7; 95% CI: 1.5-107.3). CONCLUSIONS: The treatment compliance rate of Tuberculosis infection was high among people who started therapy. Almost a half of the contacts with TI did not start treatment, and associated factors were: age, social relationship, and the TST reaction. The treatment regimen was associated with greater compliance. It is important to know the factors associated with adherence to treatment of TI in each health area, and focus efforts on risk groups; thereby approaching the global control of tuberculosis.

[Lights and shadows in patient safety: study and development of strategies. 2008 SESPAS Report]. / Luces y sombras en la seguridad de los pacientes: estudio y desarrollo de estrategias. Informe SESPAS 2008.

Study of the frequency of healthcare-related adverse events (AE) and of their effect on patients and impact on healthcare systems has markedly increased in recent years. Indepth individual analysis of the factors contributing to these events has allowed strategies to prevent or minimize the impact of AE to be developed. However, an epidemiologic perspective is needed to explore possible associations and generalize the recommendations that can be drawn from this type of analysis. Some aspects that should been considered while developing future strategies are discussed. These aspects include the importance of patient age and comorbidities on producing AE and the use of highly technological medicine, which is sometimes unnecessary. A culture of trust and confidentiality and a spirit of collaboration among organizations are indispensable to share and learn about the initiatives prompted by the study of AE and thereby improve patient safety in the national health service.

[Detection of intimate partner violence in primary care and related factors]. / Detección de violencia del compañero íntimo en atención primaria de salud y sus factores asociados.

OBJECTIVE: Intimate partner violence (IPV) against women is a significant public health and human rights problem. Primary care professionals play a key role in detecting and addressing this issue. The aim of this study is to determine the frequency of IPV and its associated factors in primary care by means of a screening questionnaire and to describe the main actions taken in identified cases. METHODS: Cross-sectional study in 15 health centres in four autonomous regions of Spain with a total of 265 health professionals. The information was collected through the self-administered PREMIS questionnaire (Physician Readiness to Manage Intimate Partner Violence Survey), which includes variables concerning screening questions, sociodemographic factors, level of training/knowledge about IPV, perceptions and actions. A descriptive and analytical study was conducted. RESULTS: 67.2% of participants said they ask about IPV during consultations. The most frequent actions were: referring patients to other departments, individual counselling and information delivery. ≥21hours of training, an advanced training level, knowledge of policies and programmes and the implementation of an appropriate protocol and reference resources were all factors that increased the likelihood of investigating IPV. The asking of questions increases in line with professionals' perceived level of training in IPV and the provision of a case management protocol. CONCLUSIONS: Two thirds of health professional respondents said they inquire about IPV. Given the influence of training in IPV and awareness of the resources to address the issue, it is essential to continue investing in the IPV training of healthcare personnel.

Eventos adversos relacionados con la medicación en los hospitales de la Comunidad Valenciana. Estudio EPIDEA 2005-2013 / Adverse events related to medication in hospitals from the Valencian Community. EPIDEA Study 2005-2013

Introducción. Determinar la prevalencia de eventos adversos relacionados con la medicación (EAM) en los hospitales de la Comunidad Valenciana en el periodo de estudio 2005-2013. Conocer los factores de riesgo asociados, su análisis e impacto. Material y métodos. El trabajo está basado en los datos y metodología del Estudio de Prevalencia de Eventos Adversos en los hospitales de la Comunidad Valenciana (EPIDEA), desde 2005 hasta 2013. Se analizaron los EAM producidos en cada año. Resultados. Se identificaron 344 EAM que ocurrieron a 337 pacientes, entre 35.103 pacientes estudiados, lo cual constituye una prevalencia de EAM de 0,96% (IC95% 0,89-1,07). Los factores de riesgo intrínseco para EAM más prevalentes fueron hipertensión, diabetes y neoplasia. Los factores de riesgo extrínseco más prevalentes fueron catéter venoso periférico, sonda urinaria cerrada y catéter venoso central. Los grupos terapéuticos más implicados fueron antibióticos sistémicos, fármacos cardiovasculares, y antineoplásicos. El 61,17% de los EAM fue clasificado como moderado, un 27,18% como leve y un 11,65 % como grave. El 33,99% de los EAM prolongaron la estancia del paciente y un 39,90% fueron causa de reingreso del paciente. Globalmente, el 58,5% de los EAM fueron evitables. Según gravedad, fueron evitables el 46.3% de los EAM leves, el 60.3% de los EAM moderados, y el 75% de los EAM graves (p=0.013). Conclusiones. La prevalencia de pacientes con EAM en la Comunidad Valenciana durante el periodo 2005-2013 fue de 0,96%. Más de la mitad de EAM fueron evitables, observándose una relación directa significativa entre la evitabilidad de los EAM con la gravedad de los mismos (AU)

Introduction. To determine the prevalence of Adverse Events related to Medication (AEM) in hospitals of the Valencian Community in the 2005-2013 study period, and to describe the associated risk factors and their impact. Material and methods. This study is based on data and methodology of the Study of Prevalence of Adverse Events in hospitals (EPIDEA), since its inception in 2005 until 2013. AEM produced in each year were analyzed. Results. We identified 344 AEM that occurred in 337 patients, among 35,103 patients studied, giving a prevalence of patients with AEM of 0.96% (IC95% 0.89-1.07). The most prevalent intrinsic risk factors for AEM were hypertension, diabetes and cancer. The most prevalent extrinsic risk factors were peripheral venous catheter, urinary catheter and central venous catheter. Therapeutic groups most frequently involved were systemic antibiotics, cardiovascular drugs and antineoplastics. The 61.17% of AEM was classified as moderate, followed by 27.18% as mild and 11.65% as severe. The 33.99% of EAM caused increase of the patient’s stay and 39.90% of EAM caused the re-entry of patient. The 58.5% of AEM were avoidable. Mild AEM were avoidable in 46.3%, moderate AEM were avoidable in 60.3% and severe AEM were in 75% (p = 0.013). Conclusions. The prevalence of patients with AEM in hospitals of the Community of Valencia for the period 2005- 2013 was 0.96%. More than half of AEM were preventable, and preventability increases significantly with the severity of the event (AU)

Detección de violencia del compañero íntimo en atención primaria de salud y sus factores asociados / Detection of intimate partner violence in primary care and related factors

Objetivo: La violencia de compañero íntimo (VCI) contra las mujeres es un importante problema de salud pública y de derechos humanos. Los profesionales de atención primaria tienen un papel clave en su detección y abordaje. El objetivo de este estudio es determinar la frecuencia y los factores asociados a la realización de preguntas de detección de VCI en atención primaria, y describir las principales acciones desarrolladas en los casos identificados. Métodos: Estudio transversal en 15 centros de salud de cuatro comunidades autónomas, con 265 profesionales sanitarios. Recogida de información mediante el cuestionario PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey) autocumplimentado, que incluye variables sobre realización de preguntas para detección, sociodemográficas, nivel de formación/conocimientos en VCI, percepciones y acciones. Se realizó un análisis descriptivo y analítico. Resultados: El 67,2% de los participantes señalan que preguntan sobre VCI en la consulta, siendo las acciones más frecuentes referir/derivar a otros servicios, consejo individual y entrega de información. Se asociaron a mayor probabilidad de indagar sobre VCI tener ≥21 de horas de formación, nivel formativo avanzado, conocer políticas y programas, y disponer de protocolo y recursos apropiados de referencia. La realización de preguntas aumenta a medida que los/las profesionales se sienten formados en VCI y provistos/as de un protocolo de manejo de casos. Conclusiones: Dos terceras partes de los/las profesionales sanitarios/as encuestados/as refirieron indagar sobre VCI. Dada la influencia de la formación en VCI y el conocimiento sobre los recursos para su abordaje, resulta imprescindible continuar invirtiendo en la formación en VCI del personal sanitario (AU)

Objective: Intimate partner violence (IPV) against women is a significant public health and human rights problem. Primary care professionals play a key role in detecting and addressing this issue. The aim of this study is to determine the frequency of IPV and its associated factors in primary care by means of a screening questionnaire and to describe the main actions taken in identified cases. Methods: Cross-sectional study in 15 health centers in four autonomous regions of Spain with a total of 265 health professionals. The information was collected through the self-administered PREMIS questionnaire (Physician Readiness to Manage Intimate Partner Violence Survey), which includes variables concerning screening questions, sociodemographic factors, level of training/knowledge about IPV, perceptions and actions. A descriptive and analytical study was conducted. Results: 67.2% of participants said they ask about IPV during consultations. The most frequent actions were: referring patients to other departments, individual counselling and information delivery. ≥21hours of training, an advanced training level, knowledge of policies and programmes and the implementation of an appropriate protocol and reference resources were all factors that increased the likelihood of investigating IPV. The asking of questions increases in line with professionals’ perceived level of training in IPV and the provision of a case management protocol. Conclusions: Two thirds of health professional respondents said they inquire about IPV. Given the influence of training in IPV and awareness of the resources to address the issue, it is essential to continue investing in the IPV training of healthcare personnel (AU)

[Social determinants of overweight and obesity in Spain in 2006]. / Determinantes sociales de sobrepeso y obesidad en España 2006.

BACKGROUND AND OBJECTIVE: Obesity in the Spanish adult population has almost doubled from 1987 to 2003. The aim is to update the prevalence of overweight and obesity, and reassess its main social determinants using the National Health Household Survey (ENS) from 2006. PATIENTS AND METHODS: Cross sectional study based on the ENS-2006. Sample of 29,478 adults who answered questions on self-reported weight and height. We calculated the body mass index (WHO classification) for the dependent variable. Sociodemographic independent variables used were age, sex, marriage status, educational level, social class (manual, non-manual), and monthly income. A descriptive study was conducted as well as different logistic regression models. RESULTS: In 2006, the prevalence of overweight is higher in men (43.9%) than women (28.9%). Sex differences were not observed in the prevalence of obesity (15.0%). The multinomial logistic regression analysis shows significant associations between obesity and marriage status: married OR=1.69 (1.51-1.89), widower OR=1.77 (1.45-2.16); population without education: OR=2.77 (2.34-3.28) and income below 600 €: OR=1.50 (1.18-1.91). There was a statistically significant interaction (p<0.001) between sex and social class. Women from manual social class have 49% more chances to be overweight and 96% greater risk of obesity compared to non-manual social class women. In addition, men of manual social class have less risk of overweight (18%) and obesity (12%) than non-manual social class men. CONCLUSIONS: Gender and socioeconomic status are key social determinants for obesity in Spain and, consequently, this needs to be addressed when developing preventive activities.

[Pre-hospital adverse events: a way to go]. / Efectos adversos prehospitalarios: un camino por recorrer.

BACKGROUND: The occurrence of adverse events is a problem at all levels of care and creates a significant burden of morbidity and mortality. In Spain there have been significant investigations of adverse effects (AE) in hospitals and primary care, however, studies of pre-hospital care are not yet developed. The aim of this study was to determine the frequency, type, preventability, severity and impact of "pre-hospital" adverse events, which were detected in the hospitalization index and the comparing those that occurred in ambulatory and non-ambulatory care. METHOD: Case Series Study, with analytical components, of a sample of subjects included in the "National study of adverse events related to hospitalization (ENEAS). Qualitative data are presented as proportions with confidence intervals. For comparative analysis of qualitative data, we used the chi-square test. RESULTS: Of a total of 5624 patients, 2.3% (N=131) ((95%)CI: 1.94-2.72) had an AE that occurred prior to hospitalization or "pre-hospital", and 40.5% of these (N=53) ((95%)CI: 32.05-48.86) were preventable. In 44 patients the AE had its origin in ambulatory care and 85 patients in non-ambulatory care. The characteristic of patients with ambulatory AE are men and older women (median 76 years) who consulted for medical problems (84.1%) and the AE were related to medication in 77.8%. The characteristic of patients with non-ambulatory AE, were men (median 73 years), consulting for medical and surgical problems (44,7-55,3%) and the EA is related to medications, infections and procedures. CONCLUSIONS: The characteristics of patients with AE and undesirable effects that occurred during pre-hospitalization period depended on whether they originated during ambulatory care or non-ambulatory care. Therefore prevention strategies should take these differences into account.

Factores asociados a la adherencia en el tratamiento de la infección tuberculosa / Factors associated with treatment adherence for tuberculosis infection

OBJETIVO: Analizar la adherencia al tratamiento de la infección tuberculosa (TIT) e identificar los factores de riesgo para su cumplimiento. DISEÑO: Estudio observacional de cohortes históricas. Emplazamiento: Hospital Universitari Sant Joan d'Alacant (Alicante). Participantes: Todos los sujetos con una prueba de tuberculina (PT) realizada durante el estudio de contactos (EC) de tuberculosis durante 6 años. RESULTADOS: Se incluyeron en el análisis 764 contactos. El 59,7% de los 566 pacientes que terminaron el EC presentaron infección tuberculosa (IT). De los pacientes con IT, el 45,6% no iniciaron tratamiento y los factores asociados fueron: edad (36-65 años; RR: 5,8; IC 95%: 1,2-27,5 y > 65 años; RR: 11,3; IC 95%: 2,0-64,0), relación social con el caso índice de tuberculosis (RR: 2,2; IC 95%: 1,2-3,8) e induración de la PT (≥ 15 mm; RR: 0,5; IC 95%: 0,3-0,9). La tasa de cumplimiento fue del 80,4% entre los que comenzaron el TIT. La pauta de tratamiento 7-9H se asoció con mayor cumplimiento del TIT (RR: 12,7; IC 95%: 1,5-107,3). CONCLUSIONES: La tasa de cumplimiento del TIT fue elevada entre los que iniciaron tratamiento. Casi la mitad de los contactos con IT no iniciaron tratamiento y los factores asociados fueron: edad, relación social e induración de la PT. La pauta de tratamiento se asoció con mayor cumplimiento. Debemos conocer con precisión los factores asociados a la adherencia al tratamiento de la IT en cada área de salud y actuar sobre los grupos de riesgo, y de esta manera aproximar el control global de la tuberculosis

OBJECTIVE: To analyze adherence to treatment of tuberculosis infection and to identify risk factors for its compliance. DESIGN: An observational historical cohort study. Setting: Hospital Universitari Sant Joan d'Alacant (Alicante). Participants: All patients with a tuberculin skin test (TST) done during tuberculosis contact tracing during 6 years. RESULTS: We included 764 tuberculosis contacts in the analysis. 59.7% of the 566 patients who completed the contact tracing, had tuberculosis infection (TI). Of the patients with TI, 45.6%had not started treatment for tuberculosis infection (TTBI). Factors associated with not starting TTBI were: age (36-65 years, RR: 5.8; 95% CI: 1.2-27.5, and > 65 years, RR: 11.3; 95% CI: 2.0-64.0), the social relationship with TB case (RR: 2.2; 95% CI 1.2-3.8), and the TST reaction (≥15 mm; RR: 0.5; 95% CI: 0.3-0.9). The completion rate for TTBI was 80.4% among people who started therapy. The treatment regimen was associated with greater compliance to TTBT (7-9H, RR: 12.7; 95% CI: 1.5-107.3). CONCLUSIONS: The treatment compliance rate of Tuberculosis infection was high among people who started therapy. Almost a half of the contacts with TI did not start treatment, and associated factors were: age, social relationship, and the TST reaction. The treatment regimen was associated with greater compliance. It is important to know the factors associated with adherence to treatment of TI in each health area, and focus efforts on risk groups; thereby approaching the global control of tuberculosis

[Adverse events in general and digestive surgery departments in Spanish hospitals]. / Sucesos adversos en cirugía general y de aparato digestivo en los hospitales españoles.

OBJECTIVE: To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. MATERIAL AND METHOD: We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. RESULTS: The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P< .001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P< .001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. CONCLUSIONS: Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority.

Luces y sombras en la seguridad de los pacientes: estudio y desarrollo de estrategias. Informe SESPAS 2008 / Lights and shadows in patient safety: study and development of strategies. 2008 SESPAS Report

El estudio sobre la frecuencia de los efectos adversos (EA) ligadosa la asistencia, su efecto en los pacientes y el impactoen los sistemas de salud ha experimentado un intenso impulsoen los últimos años. El análisis individual profundo de susfactores contribuyentes ha permitido el desarrollo de múltiplesestrategias para prevenirlos o minimizar su impacto, pero es necesariauna perspectiva epidemiológica para explorar estas posiblesasociaciones y generalizar las recomendaciones que sederiven de este análisis.Se comentan algunos de los aspectos que se deberían teneren cuenta para el desarrollo de estrategias futuras, como la importanciade la edad o las comorbilidades del paciente en la génesisde los EA y el alto grado de la instrumentalización de laasistencia (a veces innecesaria). Son imprescindibles una culturade confianza y confidencialidad y un espíritu de colaboraciónentre las organizaciones para poder compartir y aprenderde las iniciativas derivadas del estudio de los EA, y así mejorarla seguridad de los pacientes en el Sistema Nacional de Salud(AU)

Study of the frequency of healthcare-related adverseevents (AE) and of their effect on patients and impact on healthcaresystems has markedly increased in recent years. Indepthindividual analysis of the factors contributing to theseevents has allowed strategies to prevent or minimize the impactof AE to be developed. However, an epidemiologic perspectiveis needed to explore possible associations and generalizethe recommendations that can be drawn from thistype of analysis.Some aspects that should been considered while developingfuture strategies are discussed. These aspects include the importanceof patient age and comorbidities on producing AEand the use of highly technological medicine, which is sometimesunnecessary. A culture of trust and confidentiality anda spirit of collaboration among organizations are indispensableto share and learn about the initiatives prompted by thestudy of AE and thereby improve patient safety in the nationalhealth service(AU)

Determinantes sociales de sobrepeso y obesidad en España 2006 / Social determinants of overweight and obesity in Spain in 2006

Fundamento y objetivo: La obesidad en la población adulta española prácticamente se dobló entre 1987 y 2003. El objetivo de este estudio es actualizar la prevalencia de sobrepeso y obesidad, y reevaluar sus principales determinantes sociales a partir de la Encuesta Nacional de Salud (ENS) de 2006.Pacientes y método: Estudio transversal basado en la ENS-2006. Muestra de 29.478 adultos que respondieron preguntas sobre peso y talla autodeclarados. Se calculó el índice de masa corporal y la sobrecarga ponderal (clasificación de la OMS) como variable dependiente. Se usaron como variables independientes sociodemográficas: edad, sexo, estado civil, nivel de estudios, clase social (manual, no-manual) e ingresos mensuales. Se realizó un estudio descriptivo y diferentes modelos de regresión logística.Resultados: En 2006, la prevalencia de sobrepeso fue mayor en varones (43,9%) que en mujeres (28,9%), pero para la prevalencia de obesidad (15,0%) no se observaron diferencias por sexos. El análisis de regresión logística multinomial muestra asociación significativa entre obesidad-estar casada(o), con una odds ratio (OR) de 1,69 (intervalo de confianza del 95% [IC 95%] 1,51-1,89) y viuda(o), OR de 1,77 (IC 95% 1,45-2,16); sin estudios, OR de 2,77 (IC 95% 2,34-3,28) e ingresos < 600 €, OR de 1,50 (IC 95% 1,18-1,91). Se encontró una interacción estadísticamente significativa (p<0,001) entre sexo y clase social. Las mujeres de clase social manual presentan un 49% más riesgo de tener sobrepeso y un 96% más riesgo de obesidad que las mujeres de clase social no-manual. Mientras, los varones de clase social manual presentan menos riesgo de sobrepeso (18%) y obesidad (12%) frente a los de clase social manual.Conclusiones: El género y la clase social son determinantes sociales relevantes de la obesidad en España. Las actividades preventivas que se desarrollen deben considerar ambas condiciones sociales

Background and objective: Obesity in the Spanish adult population has almost doubled from 1987 to 2003. The aim is to update the prevalence of overweight and obesity, and reassess its main social determinants using the National Health Household Survey (ENS) from 2006. Patients and methods: Cross sectional study based on the ENS-2006. Sample of 29,478 adults who answered questions on self-reported weight and height. We calculated the body mass index (WHO classification) for the dependent variable. Sociodemographic independent variables used were age, sex, marriage status, educational level, social class (manual, non-manual), and monthly income. A descriptive study was conducted as well as different logistic regression models.Results: In 2006, the prevalence of overweight is higher in men (43.9%) than women (28.9%). Sex differences were not observed in the prevalence of obesity (15.0%). The multinomial logistic regression analysis shows significant associations between obesity and marriage status: married OR=1.69 (1.51-1.89), widower OR=1.77 (1.45-2.16); population without education: OR=2.77 (2.34-3.28) and income below 600 €: OR=1.50 (1.18-1.91). There was a statistically significant interaction (p<0.001) between sex and social class. Women from manual social class have 49% more chances to be overweight and 96% greater risk of obesity compared to non-manual social class women. In addition, men of manual social class have less risk of overweight (18%) and obesity (12%) than non-manual social class men. Conclusions: Gender and socioeconomic status are key social determinants for obesity in Spain and, consequently, this needs to be addressed when developing preventive activities

Efectos adversos prehospitalarios: un camino por recorrer / Pre-hospital adverse events: a way to go

AntecedentesLa ocurrencia de efectos adversos (EA) es un problema presente en todos los niveles asistenciales y genera una carga importante de morbimortalidad. En España se han realizado 2 estudios nacionales de EA: uno en hospitales y otro en atención primaria; sin embargo, aún no se han estudiado aquellos EA que detectados durante un proceso de hospitalización hubieran tenido su origen en una atención sanitaria previa. El objetivo de este estudio es conocer las características de los pacientes con EA y la frecuencia, naturaleza, evitabilidad, gravedad e impacto de los EA prehospitalarios que se detectaron en la hospitalización índice, y comparar los de origen ambulatorio y los de origen no ambulatorio.MétodoEstudio de serie de casos, con componentes analíticos, de una muestra de sujetos incluidos en el Estudio Nacional de Efectos Adversos ligados a la Hospitalización (ENEAS). Los datos cualitativos se presentan como proporciones con su intervalo de confianza (IC). Para el análisis comparativo de datos cualitativos, se utilizó el test de χ2.ResultadosDe un total de 5.624 pacientes, un 2,3% (n=131) (IC del 95%: 1,94–2,72) presentó algún EA prehospitalario, y de éstos, en el 40,5% (n=53) (IC del 95%: 32,05–48,86) el EA fue evitable. En 44 pacientes el origen del EA fue ambulatorio y en 85 pacientes el origen fue no ambulatorio.ResultadosLos pacientes con EA ambulatorio son mujeres de edad avanzada y hombres de mediana edad que consultan por problemas médicos y el EA suele estar relacionado con la utilización de medicamentos. Los pacientes con EA no ambulatorio con mayor frecuencia son hombres de edad avanzada, que ingresan en servicios tanto médicos como quirúrgicos y los EA están relacionados, además de con los medicamentos, con las infecciones nosocomiales y los procedimientos...(AU)

BackgroundThe occurrence of adverse events is a problem at all levels of care and creates a significant burden of morbidity and mortality. In Spain there have been significant investigations of adverse effects (AE) in hospitals and primary care, however, studies of pre-hospital care are not yet developed. The aim of this study was to determine the frequency, type, preventability, severity and impact of “pre-hospital” adverse events, which were detected in the hospitalization index and the comparing those that occurred in ambulatory and non-ambulatory care.MethodCase Series Study, with analytical components, of a sample of subjects included in the “National study of adverse events related to hospitalization (ENEAS). Qualitative data are presented as proportions with confidence intervals. For comparative analysis of qualitative data, we used the chi-square test.ResultsOf a total of 5624 patients, 2.3% (N=131) (95%CI: 1.94–2.72) had an AE that occurred prior to hospitalization or “pre-hospital”, and 40.5% of these (N=53) (95%CI: 32.05–48.86) were preventable. In 44 patients the AE had its origin in ambulatory care and 85 patients in non-ambulatory care.ResultsThe characteristic of patients with ambulatory AE are men and older women (median 76 years) who consulted for medical problems (84.1%) and the AE were related to medication in 77.8%. The characteristic of patients with non-ambulatory AE, were men (median 73 years), consulting for medical and surgical problems (44,7–55,3%) and the EA is related to medications, infections and procedures.ConclusionsThe characteristics of patients with AE and undesirable effects that occurred during pre-hospitalization period depended on whether they originated during ambulatory care or non-ambulatory care. Therefore prevention strategies should take these differences into account(AU)

Sucesos adversos en cirugía general y de aparato digestivo en los hospitales españoles / Adverse events in general and digestive surgery departments in Spanish hospitals

Objetivo. Determinar la incidencia de pacientes con efectos adversos (EA) en los servicios de cirugía general, describir las causas inmediatas del EA, definir los evitables y conocer su impacto. Material y método. Estudio retrospectivo de cohortes. Muestra aleatoria estratificada de 24 hospitales, 6 de tamaño pequeño (de menos de 200 camas), 13 de tamaño mediano (de 200 a 499 camas) y 5 de tamaño grande (500 camas o más). Pacientes ingresados, cuya hospitalización fuera superior a 24 h, que fueron dados de alta del 4 al 10 de junio de 2005. Se incluyeron los EA detectados durante la hospitalización y los que fueron consecuencia de episodios de hospitalización previa en el mismo hospital. Resultados. La incidencia de pacientes con EA fue del 10,5% (76/735), con un intervalo de confianza (IC) del 95%, 8,1%-12,5%. La presencia de factores de riesgo intrínsecos aumenta el riesgo de EA (el 14,8 frente al 7,2%; p = 0,001), y también lo hace la presencia de factores de riesgo extrínseco (el 16,2 frente al 7,0%; p < 0,001). La comorbilidad influyó en la aparición de EA (el 33,7 de EA frente al 2,2% sin comorbilidad; p < 0,001). La gravedad del EA se relacionó con el riesgo ASA (p = 0,036). El 41,7% de los EA se relacionó con la infección nosocomial; el 27,1%, con procedimientos, y el 24%, con la medicación. El 31,3% de los EA se consideraron leves; el 39,6%, moderados, y el 29,2%, graves. Un 36,5% se valoraron como evitables. El total de estancias adicionales provocadas por EA fueron de 527 (6,3 estancias adicionales por paciente), de las cuales 216 correspondieron a EA evitables. Conclusiones. Los pacientes de cirugía general y aparato digestivo tienen más riesgo de EA. Existen factores de vulnerabilidad, como son la edad, la comorbilidad y la aplicación de dispositivos externos. Una parte importante de los EA se relacionan con la infección nosocomial (especialmente infección de la herida quirúrgica) y también con el propio procedimiento. Finalmente, los EA tienen un impacto notable en el paciente y en una proporción considerable de casos pueden evitarse. El impacto sanitario, social y económico de los EA, hasta hace poco una epidemia silenciosa en nuestro país, convierte la necesidad de su estudio en una prioridad de salud pública (AU)

Objective. To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. Material and method. We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. Results. The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P<.001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P<.001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. Conclusions. Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority (AU)