[Magnitude and factors associated with the solitary death phenomenon of the elderly in the Valencian Community.] / Magnitud y factores asociados al fenómeno de la muerte solitaria del anciano en la Comunidad Valenciana.

OBJECTIVE: In the Valencian Community 23% of the elderly people live alone, representing the solitary death among aged persons an unwanted effect of aging. Our aim was to determine the magnitude of this phenomenon and its risk factors in the population over 64 years of the CV during the period 2015-2017. METHODS: Cross-sectional study was carried out. Household deaths of residents over 64 years of the CV during the 2015-2017 period were analyzed, with records on medical and judicial death certificates. Adjusted incidence rates, sociodemographic characteristics and causes of death were described. For the analysis of risk factors, a multivariate logistic regression was performed, taking the adjusted Odds Ratio (OR) as an association measure. A significance level α=0.05 and 95% confidence intervals (CI) were used. RESULTS: 417 cases were found. The adjusted rates were: in 2015, 17.3 (95% CI: 14.7-20.2); in 2016, 14.5 (95% CI: 12.1-17.2); and in 2017, 13.2 (95% CI: 11,0-15.8). The most frequent causes were circulatory (52.5%) and external (19.2%). After adjustment, gender (OR M / H: 2.40; 95% CI: 1.87-3.06), age (OR ≥76 / <76: 4.56; 95% CI: 3.53 -5.90), disability (OR No / Yes: 0.51; 95% CI: 0.31-0.85), season (ref: spring; summer OR: 2.34; 95% CI: 1.63-3 , 37) and population nucleus (rural / urban OR: 2.20; 95% CI 1.58-3.08), remained associated whit the MSA. CONCLUSIONS: The solitary death among aged persons is a phenomenon scarcely studied in our environment from public health. The magnitude in the CV is relevant, with a greater risk in men and at younger ages, as well as in summer and urban areas. Presenting disability represents a certain protection.

OBJETIVO: En la Comunidad Valenciana un 23% de los ancianos viven solos, representando la muerte solitaria del anciano un efecto indeseado del envejecimiento. Nuestro objetivo fue determinar la magnitud de este fenómeno y sus factores de riesgo en la población mayor de 64 años de la CV durante el período 2015-2017. METODOS: Estudio observacional, transversal. Se analizaron las defunciones domiciliarias de residentes mayores de 64 años de la CV durante el período 2015-2017, con datos de los certificados médicos y judiciales de defunción. Se describieron las tasas de incidencia ajustadas, características sociodemográficas y causas de muerte. Para el análisis de factores de riesgo se realizó una regresión logística multivariante tomando como medida de asociación la Razón de Odds (OR) ajustada. Se usó un nivel de significación α=0,05 y unos IC del 95%. RESULTADOS: Se encontraron 417 casos. Las tasas ajustadas fueron: en 2015, 17,3 (IC95%: 14,7-20,2); en 2016, 14,5 (IC95%: 12,1-17,2); y en 2017, 13,2 (IC95%: 11,0-15,8). Las causas más frecuentes fueron circulatorias (52,5%) y externas (19,2%). Los factores asociados a la MSA fueron el sexo (OR M/H: 2,40; IC95%: 1,87-3,06), edad (OR ≥76/<76: 4,56; IC95%: 3,53-5,90), discapacidad (OR No/Sí: 0,51; IC95%: 0,31-0,85), estación (ref: primavera; OR verano: 2,34; IC95%: 1,63-3,37) y núcleo de población (OR rural/urbano: 2,20; IC95%1,58-3,08). CONCLUSIONES: La magnitud de la muerte en solitario en la Comunidad Valenciana es relevante, existiendo un mayor riesgo en hombres y a edades más tempranas, así como en verano y áreas urbanas. Presentar discapacidad representa una cierta protección.

Towards a New Strategy for Diagnosis of Congenital Trypanosoma cruzi Infection.

The immigration of Latin American women of childbearing age has spread the congenital transmission of Chagas disease to areas of nonendemicity, and the disease is now a worldwide problem. Some European health authorities have implemented screening programs to prevent vertical transmission, but the lack of a uniform protocol calls for the urgent establishment of a new strategy common to all laboratories. Our aims were to (i) analyze the trend of passive IgG antibodies in the newborn by means of five serological tests for the diagnosis and follow-up of congenital Trypanosoma cruzi infection, (ii) assess the utility of these techniques for diagnosing a congenital transmission, and (iii) propose a strategy for a prompt, efficient, and cost-effective diagnosis of T. cruzi infection. In noninfected newborns, a continuous decreasing trend of passive IgG antibodies was observed, but none of the serological assays seroreverted in any the infants before 12 months. From 12 months onwards, serological tests achieved negative results in all the samples analyzed, with the exception of the highly sensitive chemiluminescent microparticle immunoassay (CMIA). In contrast, in congenitally infected infants, the antibody decline was detected only after treatment initiation. In order to improve the diagnosis of congenital T. cruzi infection, we propose a new strategy involving fewer tests that allows significant cost savings. The protocol could start 1 month after birth with a parasitological test and/or a PCR. If negative, a serological test would be carried out at 9 months, which if positive, would be followed by another at around 12 months for confirmation.

Serological Diagnosis of Chronic Chagas Disease: Is It Time for a Change?

Chagas disease has spread to areas that are nonendemic for the disease with human migration. Since no single reference standard test is available, serological diagnosis of chronic Chagas disease requires at least two tests. New-generation techniques have significantly improved the accuracy of Chagas disease diagnosis by the use of a large mixture of recombinant antigens with different detection systems, such as chemiluminescence. The aim of the present study was to assess the overall accuracy of a new-generation kit, the Architect Chagas (cutoff, ≥1 sample relative light units/cutoff value [S/CO]), as a single technique for the diagnosis of chronic Chagas disease. The Architect Chagas showed a sensitivity of 100% (95% confidence interval [CI], 99.5 to 100%) and a specificity of 97.6% (95% CI, 95.2 to 99.9%). Five out of six false-positive serum samples were a consequence of cross-reactivity with Leishmania spp., and all of them achieved results of <5 S/CO. We propose the Architect Chagas as a single technique for screening in blood banks and for routine diagnosis in clinical laboratories. Only gray-zone and positive sera with a result of ≤6 S/CO would need to be confirmed by a second serological assay, thus avoiding false-positive sera and the problem of cross-reactivity with Leishmania species. The application of this proposal would result in important savings in the cost of Chagas disease diagnosis and therefore in the management and control of the disease.

COSMOS - a study comparing peripheral intravenous systems.

In many areas of the world, safety peripheral intravenous systems have come into widespread use. The Madrid region was the first in Spain to adopt such an approach. These systems, though initially introduced to protect users from sharps injuries, have now evolved to include patient protection features as well. Patient protection, simply stated, means closing the system to pathogen entry. The authors' purpose was to investigate, in a prospective and randomized study, the clinical performance of a closed safe intravenous system versus an open system (COSMOS - Compact Closed System versus Mounted Open System). COSMOS is designed to provide definitive answers, from a nursing perspective, to many topics related to peripheral venous catheterization, which have important implications in intravenous therapy and which have not been validated scientifically. Furthermore, it forms pioneering research in that it is the first clinical trial on medical devices in a legislated environment carried out entirely by nurses and whose promoter and principal investigator is a nurse. The objectives of COSMOS are to compare the effectiveness (as defined by time of survival without complications) and rates of catheter-related complications, such as phlebitis, pain, extravasation, blockage and catheter-related infections. It also looks at rates of catheter colonization, the ease of handling of both systems and overall costs. This article outlines the authors' approach, both in preparing hospital units for such an evaluation as well as in the choice of parameters and their method of study. Further articles will detail the results and findings of the study.