Perfil epidemiológico y cobertura vacunal en pacientes esplenectomizados en un área sanitaria de Murcia (1993-2012) / Epidemiological profile and vaccination coverage in splenectomy patients in a health area of Murcia (1993-2012)

OBJETIVO: Los pacientes asplénicos tienen un elevado riesgo de infecciones graves, muchas prevenibles mediante vacunación. El objetivo del estudio fue analizar las características clinicoepidemiológicas y cobertura vacunal de estos pacientes en el Área III de Salud de la Región de Murcia. MÉTODO: Estudio transversal cuya población de estudio fueron pacientes esplenectomizados durante 1993-2012, según el Registro del Conjunto Mínimo Básico de Datos. Los pacientes se clasificaron por motivo de esplenectomía (neoplasias, enfermedades hematológicas, traumatismos y otras), estado vacunal y estado vital. Para ello se utilizaron los registros oficiales de datos sanitarios. El análisis estadístico se realizó con el programa estadístico SPSS 21.0. RESULTADOS: La muestra se constituyó por 196 pacientes. El 68,4% (n=134) eran hombres. La edad media a la que se les practicó la esplenectomía fue a los 50,1 años (DE: 22,2). El motivo más frecuente de la extirpación del bazo fue la neoplasia en un 39,1% (n=59). La esplenectomía por motivos traumatológicos se asoció a una menor edad del paciente (p < 0,001) y género masculino (p = 0,03). La cobertura de vacunación para Streptococcus pneumoniae fue del 23,8%, 5,7% para Neisseria meningitidis serogrupo C, y 8,6% para Haemophilus influenzae B. Solo el 2,9% de los enfermos se encontraban correctamente vacunados para las tres. CONCLUSIONES: Las coberturas vacunales fueron insuficientes para este perfil de paciente frágil. Se debe incidir en la captación precoz y asesoramiento en este colectivo tan susceptible a la enfermedad, siendo los profesionales de enfermería piezas determinantes en el proceso

OBJECTIVE: Splenectomy patients have a high risk of suffering severe infections, many of them preventable by vaccination. The aim of the study was to analyse the clinical epidemiological characteristics and vaccine coverage of these patients in Health Area III of the Region of Murcia. METHOD: A cross-sectional study was conducted on a population of patients that were splenectomised during the period 1993-2012, according to the Register of the Basic Minimum Data Set. Patients were classified on the basis of splenectomy (neoplasm, haematological diseases, trauma, and others), vaccination, and vital status, using official records of health data. Statistical analysis was performed using SPSS 21.0 statistics program. RESULTS: The sample consisted of 196 patients, of which 68.4% (n=134) were male. The mean age at which they underwent splenectomy was 50.1 years (SD: 22.2). The most common reason for removal of the spleen was neoplasia in 39.1% (n=59). Splenectomy due to trauma reasons was associated with lower patient age (p<.001) and male gender (p=.03). Vaccination coverage for Streptococcus pneumoniae was 23.8%, 5.7% for Neisseria meningitidis C, and 8.6% for Haemophilus influenzae B. Only 2.9% of patients were correctly vaccinated for all three. CONCLUSIONS: Vaccination coverage was insufficient for this fragile patient profile. It should be taken into account in the early detection and counselling in this group so susceptible to disease, with nurses being a decisive part in the process

Epidemiological profile and vaccination coverage in splenectomy patients in a health area of Murcia (1993-2012). / Perfil epidemiológico y cobertura vacunal en pacientes esplenectomizados en un área sanitaria de Murcia (1993-2012).

OBJECTIVE: Splenectomy patients have a high risk of suffering severe infections, many of them preventable by vaccination. The aim of the study was to analyse the clinical epidemiological characteristics and vaccine coverage of these patients in Health Area III of the Region of Murcia. METHOD: A cross-sectional study was conducted on a population of patients that were splenectomised during the period 1993-2012, according to the Register of the Basic Minimum Data Set. Patients were classified on the basis of splenectomy (neoplasm, haematological diseases, trauma, and others), vaccination, and vital status, using official records of health data. Statistical analysis was performed using SPSS 21.0 statistics program. RESULTS: The sample consisted of 196 patients, of which 68.4% (n=134) were male. The mean age at which they underwent splenectomy was 50.1 years (SD: 22.2). The most common reason for removal of the spleen was neoplasia in 39.1% (n=59). Splenectomy due to trauma reasons was associated with lower patient age (p<.001) and male gender (p=.03). Vaccination coverage for Streptococcus pneumoniae was 23.8%, 5.7% for Neisseria meningitidis C, and 8.6% for Haemophilus influenzae B. Only 2.9% of patients were correctly vaccinated for all three. CONCLUSIONS: Vaccination coverage was insufficient for this fragile patient profile. It should be taken into account in the early detection and counselling in this group so susceptible to disease, with nurses being a decisive part in the process.

Vaccination campaign at a temporary camp for victims of the earthquake in Lorca (Spain).

Outbreaks in temporary camps are an important risk for the health of the displaced population. The town of Lorca (Murcia, Spain) suffered 2 earthquakes on May 2011 that required the re-housing of 1,424 victims in a temporary camp. Following 4 cases of chickenpox control measures were adopted among the displaced population. These measures included vaccination against chickenpox; due to the existence of cases of measles in adjacent regions, it was decided to offer measles, mumps and rubella (MMR) vaccination as well. The immunization campaign was performed during 2 d (3 to 4 d after the first case). The immunity status of 1,041 (73,1%) of the residents was reviewed. Being vaccinated 523 (67%) against chickenpox and MMR, 133 (17%) against only MMR and 124 (16%) against only chickenpox. We consider the action taken was a success, as only 4 additional cases of chickenpox were subsequently recorded in the campsite, being avoidable only one of them. There is a major risk of outbreaks in a disaster situation. Because of this, conducting preventive actions are indicated to avoid doing worse this critical.

Competencia en práctica basada en la evidencia en estudiantes del Grado en Enfermería / Evidence-based practice competence in undergraduate Nursing Degree students

OBJETIVOS: El aprendizaje de la práctica basada en la evidencia (PBE) se ha convertido en un aspecto clave en la formación de profesionales de Enfermería. En el nuevo plan de estudios del Grado en Enfermería de la Universidad de Murcia (UM) se incluyó una asignatura específica sobre PBE en cuarto curso. El objetivo del presente estudio es conocer el nivel de competencia en PBE en estudiantes del Grado en Enfermería de la UM y comparar los resultados entre los 4 cursos. MÉTODO: Estudio observacional descriptive transversal. Población de estudio: estudiantes de los 4 cursos del Grado en Enfermería de la Facultad de Ciencias Sociosanitarias de la UM, curso 2013-14. Se utilizó el cuestionario validado CACH-PBE que evalúa competencia en PBE y sus dimensiones: actitud, habilidades y conocimientos. El rango de la escala es: 1 punto «nivel más bajo» a 5 puntos «nivel más alto». Se realizaron análisis descriptivos y bivariantes con el programa SPSS 21.0. RESULTADOS: Participaron 144 estudiantes, el 76,4% eran mujeres, la mediana de edad fue de 23 años. El 84,7% asistieron a más del 75% de horas de clase. Las diferencias de medias en el cuestionario entre primero y cuarto fueron de 0,58 puntos en actitud, 0,60 en habilidades, 1,6 en conocimientos y 0,83 en competencia global. Los estudiantes de cuarto curso obtuvieron puntuaciones medias significativamente más altas que el resto de cursos (p < 0,05) en todas las dimensiones y en la competencia global en PBE. CONCLUSIONES: Los estudiantes del Grado en Enfermería estudiado adquieren un adecuado nivel de competencia en PBE. El mayor incremento ocurre en cuarto curso

AIM: Evidence-based practice (EBP) learning has become a key issue for nurses. An EPB subject was included in the 4th year in the new syllabus of the Nursing Degree at University of Murcia (UM). To know the competence level in EBP of undergraduate nursing students at UM and compare the results between all four years. Method: Observational descriptive study with a cross-sectional approach. Study population: undergraduate nursing students from all four years at Nursing Degree at the Faculty of Social and Healthcare Science at UM in the year 2013-14. EBP evaluation of competence of the nursing students consisted of attitude, skills and knowledge on EBP. A validated questionnaire, the EBP-COQ, was used. The scale range is 1 point «lowest level» to 5 points «higher level». The SPSS 21.0 program has been used to carry out descriptive and bivariate analyses. RESULTS: 144 students were included, 76.4% was female, and the median age was 23 years, 84.7% attended more than 75% class hours. The mean differences in the questionnaire between first and fourth years were 0.58 points in attitude, 0.60 in skills, 1.6 in knowledge and 0.83 in global competence in EBP. Significant differences in mean scores between the fourth and the remaining years in the global competence in EBP were observed, as well as in the three dimensions (p < 0.05). CONCLUSIONS: The undergraduate-nursing students studied here have acquired an appropriate competence level in EBP, with a gradual increase by year. The biggest increase was in the fourth year students

[Evidence-based practice competence in undergraduate Nursing Degree students]. / Competencia en práctica basada en la evidencia en estudiantes del Grado en Enfermería.

AIM: Evidence-based practice (EBP) learning has become a key issue for nurses. An EPB subject was included in the 4(th) year in the new syllabus of the Nursing Degree at University of Murcia (UM). To know the competence level in EBP of undergraduate nursing students at UM and compare the results between all four years. METHOD: Observational descriptive study with a cross-sectional approach. STUDY POPULATION: undergraduate nursing students from all four years at Nursing Degree at the Faculty of Social and Healthcare Science at UM in the year 2013-14. EBP evaluation of competence of the nursing students consisted of attitude, skills and knowledge on EBP. A validated questionnaire, the EBP-COQ, was used. The scale range is 1 point «lowest level¼ to 5 points «higher level¼.The SPSS 21.0 program has been used to carry out descriptive and bivariate analyses. RESULTS: 144 students were included, 76.4% was female, and the median age was 23 years, 84.7% attended more than 75% class hours. The mean differences in the questionnaire between first and fourth years were 0.58 points in attitude, 0.60 in skills, 1.6 in knowledge and 0.83 in global competence in EBP. Significant differences in mean scores between the fourth and the remaining years in the global competence in EBP were observed, as well as in the three dimensions (p <0.05). CONCLUSION: The undergraduate-nursing students studied here have acquired an appropriate competence level in EBP, with a gradual increase by year. The biggest increase was in the fourth year students.

Influencia del fenómeno migratorio sobre la tuberculosis en una zona semiurbana / Influence of Migration on Tuberculosis in a Semi-Urban Area

Objetivos: Describir las características epidemiológicas de la tuberculosis y analizar las diferencias existentes entre pacientes autóctonos e inmigrantes en el Área III de Salud de la Región de Murcia. Métodos: Estudio de cohortes retrospectivo de casos de tuberculosis declarados al Servicio de Vigilancia Epidemiológica en el periodo 2004-2009. La recogida de datos se realizó a través del sistema de enfermedades de declaración obligatoria, la revisión de historias clínicas y las encuestas epidemiológicas. Resultados: Se detectaron 162 casos, y 110 (67,9%) correspondían a inmigrantes, cuyas tasas de incidencia oscilaron de 43,4 a 101,2 casos/100.000 habitantes. Los principales países de procedencia fueron Ecuador (42,7%), Bolivia (30%) y Marruecos (18,2%).En el momento del diagnóstico, el colectivo inmigrante era más joven que la población española (p < 0,001). El retraso diagnóstico global fue de 50,5 días: 59,5 en españoles y 47 en extranjeros. Los marroquíes presentaron mayor proporción de tuberculosis extrapulmonares (p = 0,02). La población inmigrante realizó mayoritariamente tratamiento con 4 fármacos (p < 0,001). La población autóctona tuvo mejor adherencia al tratamiento tuberculostático (p = 0,04) y la enfermedad se asoció al tabaquismo (p < 0,001), al alcoholismo (p = 0,01) y al uso de drogas parenterales (p < 0,001), mientras que en el colectivo inmigrante el factor de riesgo más relevante fue el hacinamiento (p < 0,001). Conclusiones: Las tasas de incidencia de tuberculosis son muy elevadas en población inmigrante. El principal factor de riesgo medible en este colectivo es el hacinamiento, mientras que en la población española se asocia al consumo de sustancias tóxicas y a una mayor edad

Aims: To describe the epidemiology of tuberculosis and analyzing the differences among native and immigrant patients in Area III of the Region of Murcia. Methods: Cohort study of tuberculosis cases reported to the Epidemiological Surveillance Service from 2004 to 2009. Data collection was performed through the System of Notification Diseases, reviewing clinical files and epidemiological surveys. Results: One hundred and sixty two cases were detected; 110 (67.9%) were immigrants, whose incidence rates ranged from 43.4 to 101.2 cases per 100 000 inhabitants. Ecuador (42.7%), Bolivia (30%) and Morocco (18.2%) were the main nationalities. Immigrants were younger than Spanish population (P < 0.001). The overall diagnostic delay was 50.5 days: 59.5 in Spanish and 47 in foreigners. Moroccans had higher proportions of extrapulmonary TB (P = 0.02). Mainly, immigrant population took treatment with four drugs (P < 0.001). Natives had better treatment adherence (P = 0.04). Spanish cases of tuberculosis were associated with smoking (P < 0.001), the same as alcohol consumption (P = 0.01) and injection drug use (P < 0.001), nevertheless in the foreign-born population the most relevant risk factor was overcrowding (P < 0.001). Conclusions: The incidence of tuberculosis rates are higher among immigrant population, where the main risk factor is overcrowding. In contrast, Spanish cases are associated with toxic substances consumption and increasing age

Influence of migration on tuberculosis in a semi-urban area.

AIMS: To describe the epidemiology of tuberculosis and analyzing the differences among native and immigrant patients in Area III of the Region of Murcia. METHODS: Cohort study of tuberculosis cases reported to the Epidemiological Surveillance Service from 2004 to 2009. Data collection was performed through the System of Notification Diseases, reviewing clinical files and epidemiological surveys. RESULTS: One hundred sixty two cases were detected; 110 (67.9%) were immigrants, whose incidence rates ranged from 43.4 to 101.2 cases per 100,000 inhabitants. Ecuador (42.7%), Bolivia (30%) and Morocco (18.2%) were the main nationalities. Immigrants were younger than Spanish population (P<.001). The overall diagnostic delay was 50.5 days: 59.5 in Spanish and 47 in foreigners. Moroccans had higher proportions of extrapulmonary TB (P=.02). Mainly, immigrant population took treatment with four drugs (P<.001). Natives had better treatment adherence (P=.04). Spanish cases tuberculosis were associated with smoking (P<.001), the same as alcohol consumption (P=.01) and injection drug use (P<.001), nevertheless in the foreign-born population the most relevant risk factor was overcrowding (P<.001). CONCLUSIONS: The incidence tuberculosis rates are higher among immigrant population, whose the main risk factor is overcrowding. In contrast, Spanish cases are associated with toxic substances consumption and increasing age.