Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe.

BACKGROUND: Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. METHODS: Cross-sectional study using data collected from the European Health Interview Survey 2013-2015 of individuals aged 40-74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. RESULTS: 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43-8.15; colorectal screening aOR: 1.87, 95% CI: 1.80-1.95; mammography aOR: 1.76, 95% CI: 1.69-1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85-1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. CONCLUSIONS: Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening.

A Technological Tool Aimed at Self-Care in Patients With Multimorbidity: Cross-Sectional Usability Study.

BACKGROUND: Information and communication technologies (ICTs) have been positioned as useful tools to facilitate self-care. The interaction between a patient and technology, known as usability, is particularly important for achieving positive health outcomes. Specific characteristics of patients with chronic diseases, including multimorbidity, can affect their interaction with different technologies. Thus, studying the usability of ICTs in the field of multimorbidity has become a key element to ensure their relevant role in promoting self-care. OBJECTIVE: The aim of this study was to analyze the usability of a technological tool dedicated to health and self-care in patients with multimorbidity in primary care. METHODS: A descriptive observational cross-sectional usability study was performed framed in the clinical trial in the primary care health centers of Madrid Health Service of the TeNDER (Affective Based Integrated Care for Better Quality of Life) project. The TeNDER technological tool integrates sensors for monitoring physical and sleep activity along with a mobile app for consulting the data collected and working with self-management tools. This project included patients over 60 years of age who had one or more chronic diseases, at least one of which was mild-moderate cognitive impairment, Parkinson disease, or cardiovascular disease. From the 250 patients included in the project, 38 agreed to participate in the usability study. The usability variables investigated were effectiveness, which was determined by the degree of completion and the total number of errors per task; efficiency, evaluated as the average time to perform each task; and satisfaction, quantified by the System Usability Scale. Five tasks were evaluated based on real case scenarios. Usability variables were analyzed according to the sociodemographic and clinical characteristics of patients. A logistic regression model was constructed to estimate the factors associated with the type of support provided for task completion. RESULTS: The median age of the 38 participants was 75 (IQR 72.0-79.0) years. There was a slight majority of women (20/38, 52.6%) and the participants had a median of 8 (IQR 7.0-11.0) chronic diseases. Thirty patients completed the usability study, with a usability effectiveness result of 89.3% (134/150 tasks completed). Among the 30 patients, 66.7% (n=20) completed all tasks and 56.7% (17/30) required personalized help on at least one task. In the multivariate analysis, educational level emerged as a facilitating factor for independent task completion (odds ratio 1.79, 95% CI 0.47-6.83). The median time to complete the total tasks was 296 seconds (IQR 210.0-397.0) and the median satisfaction score was 55 (IQR 45.0-62.5) out of 100. CONCLUSIONS: Although usability effectiveness was high, the poor efficiency and usability satisfaction scores suggest that there are other factors that may interfere with the results. Multimorbidity was not confirmed to be a key factor affecting the usability of the technological tool. TRIAL REGISTRATION: Clinicaltrials.gov NCT05681065; https://clinicaltrials.gov/study/NCT05681065.

Patterns of multimorbidity in primary care electronic health records: A systematic review.

Background: Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a complex phenomenon that is highly prevalent in primary care settings, particularly in older individuals. This systematic review summarises the current evidence on multimorbidity patterns identified in primary care electronic health record (EHR) data. Methods: Three databases were searched from inception to April 2022 to identify studies that derived original multimorbidity patterns from primary care EHR data. The quality of the included studies was assessed using a modified version of the Newcastle-Ottawa Quality Assessment Scale. Results: Sixteen studies were included in this systematic review, none of which was of low quality. Most studies were conducted in Spain, and only one study was conducted outside of Europe. The prevalence of multimorbidity (i.e. two or more conditions) ranged from 14.0% to 93.9%. The most common stratification variable in disease clustering models was sex, followed by age and calendar year. Despite significant heterogeneity in clustering methods and disease classification tools, consistent patterns of multimorbidity emerged. Mental health and cardiovascular patterns were identified in all studies, often in combination with diseases of other organ systems (e.g. neurological, endocrine). Discussion: These findings emphasise the frequent coexistence of physical and mental health conditions in primary care, and provide useful information for the development of targeted preventive and management strategies. Future research should explore mechanisms underlying multimorbidity patterns, prioritise methodological harmonisation to facilitate the comparability of findings, and promote the use of EHR data globally to enhance our understanding of multimorbidity in more diverse populations.

COVID persistente: prevalencia, seguimiento y uso de recursos en Atención Primaria / Long COVID: prevalence, monitoring and use of resources in Primary Care

Objetivo: estimar la prevalencia de la COVID persistente, signos y síntomas, y uso de recursos en pacientes en Atención Primaria (AP). Métodos: estudio observacional, descriptivo y retrospectivo de una serie de casos realizado en AP. Se incluyeron pacientes mayores de 18 años positivos para SARS-CoV-2 del 29 de febrero al 15 de abril de 2020. Se registraron variables clínicas y de uso de recursos, desde 4 hasta 39 semanas tras el diagnóstico. Resultados: la edad media de los 267 pacientes fue 57 años (desviación estándar [DE]: 16,0), siendo el 55,8% mujeres. La prevalencia de la COVID persistente fue del 45,7% (intervalo de confianza [IC] 95%: 39,6-51,9), y el 53,3% tuvo síntomas más de 12 semanas. Los síntomas más comunes fueron disnea (45,1%; IC 95%: 36,1-54,3), astenia (42,6%; IC 95%: 33,7-51,9), tos (24,6%; IC 95%: 17,2-33,2) y trastornos neuropsiquiátricos (18%; IC 95%: 11,7-26). El 98,4% de pacientes con COVID persistente precisó seguimiento en AP, con 6,7 (DE: 5,0) citas de media. El 45,1% necesitó pruebas de laboratorio; el 34,4%, radiografías de tórax, y el 41,8%, baja laboral. El 20,5% requirió derivaciones hospitalarias, frente al 3,4% en pacientes sin COVID persistente. Los factores asociados a mayor número de citas con AP incluyeron padecer COVID persistente (razón de riesgo de incidencia [RRI]: 2,9; IC 95%: 2,5-3,4) y precisar baja laboral (RRI: 2,4, IC 95%: 2,1-2,9). Conclusión: casi la mitad de los pacientes seguidos en la primera ola desarrollaron COVID persistente. Los síntomas persistentes más frecuentes fueron disnea, astenia y tos. El uso de recursos fue hasta seis veces mayor en pacientes con COVID persistente, frente a aquellos que no lo desarrollaron. (AU)

Aim: to estimate the prevalence of long COVID, its signs and symptoms and use of resources in adult patients in primary care (PC). Methods: an observational, descriptive, retrospective case series study performed in primary care. Patients older than 18 years positive for SARS-CoV-2 from 29 February until 15 April 2020 were included. Variables related to clinical symptoms and use of resources were recorded from four weeks after diagnosis up to 39 weeks. Results: mean age of the 267 patients was 57 years old (16.0 SD); 55,8% were women. In the acute phase, 61.8% of patients required hospitalization and 43.8% suffered bilateral pneumonia. Long COVID prevalence was 45,7% (95% CI 39.6-51.9), and 53.3% had symptoms lasting longer than 12 weeks. Most common symptoms were dyspnoea (45.1%, 95% CI 36.1-54.3), asthenia (42.6%, 95% CI 33.7-51.9), cough (24.6%, 95% CI 17.2-33.2) and neuropsychiatric disorders (18%, 95% CI 11.7-26.0). A total of 98.4% of long COVID patients contacted primary care during follow-up, with 6.7 (5.0 SD) contacts on average. A total of 45.1%, 34.4% and 41.8% underwent laboratory tests, chest x-rays and required work leave, respectively. Long COVID patients needed more hospital referrals (20.5%) compared to those who did not develop this (3.4%). Factors associated with more primary care appointments included developing long COVID (IRR 2.9, 95% CI 2.5-3.4) and requiring a work leave (IRR 2.4, 95% CI 2.1-2.9). Conclusion: virtually half of patients developed long COVID. Most common chronic symptoms were dyspnoea, asthenia and cough. Use of resources was two to six times greater among long COVID patients, in contrast to those who did not develop long COVID. (AU)

Sex and income inequalities in preventive services in diabetes.

BACKGROUND: Cancer preventive services (gynaecological cancer screening, colon cancer screening) and cardiometabolic screening are recommended by guidelines to individuals. People with diabetes were less likely to receive them than those without diabetes in some studies. OBJECTIVES: To analyse differences in the coverage of preventive services in people with diabetes compared to non-diabetic individuals and in people with diabetes according to sex and household income. METHODS: We analysed data collected from the European Health Interview Survey 2013-2015, including individuals aged 40-74 (n = 179,318), 15,172 with diabetes from 29 countries. The income of a household (HHI) was described in quintiles. The relationship between the coverage of preventive services (cardiometabolic, vaccination, cancer screening) and sociodemographic characteristics was analysed with multiple logistic regression. RESULTS: Women comprised 53.8% of the total and 40% were 60-74 years. People with diabetes compared to those without diabetes had higher reported coverage of cardiometabolic screening (98.4% vs. 90.0% in cholesterol measurement; 97.0% vs. 93.6% in blood pressure measurement), colorectal cancer screening (27.1% vs. 24.6%) but lower coverage of gynaecological cancer screening (mammography: 29.2% vs. 33.5%, pap smear test: 28.3% vs. 37.9%). Among diabetic patients, women were less likely to receive cholesterol screening (OR = 0.81; 95% CI: 0.72-0.91) and colon cancer screening (OR = 0.79; 95% CI: 0.73-0.86) compared to men. Being affluent was positively associated with receiving cardiometabolic screening and mammography in diabetic patients. CONCLUSION: People with diabetes reported higher coverage of preventive services except gynaecological cancer screening. Disparities were found in diabetes among women and less affluent individuals.

Actinomycete Potential as Biocontrol Agent of Phytopathogenic Fungi: Mechanisms, Source, and Applications.

Synthetic fungicides have been the main control of phytopathogenic fungi. However, they cause harm to humans, animals, and the environment, as well as generating resistance in phytopathogenic fungi. In the last few decades, the use of microorganisms as biocontrol agents of phytopathogenic fungi has been an alternative to synthetic fungicide application. Actinomycetes isolated from terrestrial, marine, wetland, saline, and endophyte environments have been used for phytopathogenic fungus biocontrol. At present, there is a need for searching new secondary compounds and metabolites of different isolation sources of actinomycetes; however, little information is available on those isolated from other environments as biocontrol agents in agriculture. Therefore, the objective of this review is to compare the antifungal activity and the main mechanisms of action in actinomycetes isolated from different environments and to describe recent achievements of their application in agriculture. Although actinomycetes have potential as biocontrol agents of phytopathogenic fungi, few studies of actinomycetes are available of those from marine, saline, and wetland environments, which have equal or greater potential as biocontrol agents than isolates of actinomycetes from terrestrial environments.

Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster.

BACKGROUND: Clinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed. METHODS: A multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods. RESULTS: Two hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15-0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5-55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02-1.21). CONCLUSIONS: The game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02210442 . Registered 6 August 2014.

[What have we missed because of COVID-19? Missed diagnoses and delayed follow-ups. SESPAS Report 2022]. / ¿Qué hemos dejado de atender por la COVID-19? Diagnósticos perdidos y seguimientos demorados. Informe SESPAS 2022.

The COVID-19 pandemic and the associated public health emergency have affected patients and health services in non-COVID-19 pathologies. Several studies have shown its dissociation from health services, with a decrease in emergency department visits, in hospital admissions for non-COVID-19 pathologies, as well as in the reported weekly incidence of acute illnesses and new diagnoses in primary care. In parallel, the pandemic has had direct and indirect effects on people with chronic diseases; the difficulties in accessing health services, the interruption of care, the saturation of the system itself and its reorientation towards non-face-to-face formats has reduced the capacity to prevent or control chronic diseases. All this has also had an impact on the different areas of people's lives, creating new social and economic difficulties, or aggravating those that existed before the pandemic. All these circumstances have changed with each epidemic wave. We present a review of the most relevant studies that have been analyzing this problem and incorporate as a case study the results of a retrospective observational study carried out in Primary Care in the Madrid Health Service, which provides health coverage to a population of more than 6 million people, and whose objective was to analyze the loss of new diagnoses in the most prevalent pathologies such as common mental health problems, cardiovascular and cerebrovascular diseases, type 2 diabetes, chronic obstructive pulmonary disease, and breast and colon tumors, in the first and second waves. Annual incidence rates with their confidence interval were calculated for each pathology and the monthly frequency of new codes recorded between 1/01/2020 and 12/31/2020 was compared with the monthly mean of observed counts for the same months between 2016 and 2019. The annual incidence rate for all processes studied decreased in 2020 except for anxiety disorders. Regarding the recovery of lost diagnoses, heart failure is the only diagnosis showing an above-average recovery after the first wave. To return to pre-pandemic levels of diagnosis and follow-up of non-COVID-19 pathology, the healthcare system must reorganize and contemplate specific actions for the groups at highest risk.

Integra Dermal Regeneration Template in reconstructive surgery for cutaneous tumours: a two-year retrospective review.

OBJECTIVE: Integra Dermal Regeneration Template (IDRT) (Integra LifeSciences, US) is a bioengineered dermal matrix that has been widely used in burn reconstruction since its first description. However, little is reported on its use in oncologic dermatological defects. Our objective was to evaluate reconstruction using IDRT on cutaneous tumour defects. METHOD: We conducted a two-year retrospective review of patients with skin tumours who had an excision surgery, followed by reconstruction with IDRT, as a mid-step towards a final autograft procedure: a split-thickness skin graft. The records of all patients at a single academic institution were queried from the electronic medical record using data obtained from the operating surgeon. RESULTS: We identified 13 patients with different tumour types and locations. The mean defect size was 105.92cm². The matrix take rate was 92.3% and average postoperative day for definite autograft was 20 days. Patients were followed for a period of up to 12 months. Of the patients, one had exposed bone without periosteum; another patient showed recurrence six months after matrix placement, requiring a new second two-stage IDRT-autograft procedure before radiation therapy. Patients reported complete satisfaction with the cosmetic, functional and oncological results. No cases of infection were encountered. CONCLUSION: IDRT is a valid option for the reconstruction of oncologic surgical defects of the skin and can be used in different anatomical locations. Specifically, it is an alternative to the reconstructive ladder when grafts and local flaps are not possible in those patients, and an option for patients who will eventually need adjuvant radiotherapy.

Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial.

BACKGROUND: The progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process. OBJECTIVE: To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care. METHODS/DESIGN: This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient. POPULATION: Patients aged 65-74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included. SAMPLE SIZE: n = 1148 patients (574 per study arm). INTERVENTION: Complex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system. OUTCOMES: The primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables. STATISTICAL ANALYSIS: The main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle. DISCUSSION: It is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04147130 . Registered on 22 October 2019.

How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention.

(1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65-74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was -2.42 (95% CI from -4.27 to -0.59) and, between baseline and a 12-month follow-up was -3.40 (95% CI from -5.45 to -1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: Clinicaltrials.gov NCT02866799.

Psychological impact of the COVID-19 pandemic on primary care workers: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has had a major impact on the mental health of healthcare workers, yet studies in primary care workers are scarce. AIM: To investigate the prevalence of and associated factors for psychological distress in primary care workers during the first COVID-19 outbreak. DESIGN AND SETTING: This was a multicentre, cross-sectional, web-based survey conducted in primary healthcare workers in Spain, between May and September 2020. METHOD: Healthcare workers were invited to complete a survey to evaluate sociodemographic and work-related characteristics, COVID-19 infection status, exposure to patients with COVID-19, and resilience (using the Connor-Davidson Resilience Scale), in addition to being screened for common mental disorders (depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder). Positive screening for any of these disorders was analysed globally using the term 'any current mental disorder'. RESULTS: A total of 2928 primary care professionals participated in the survey. Of them, 43.7% (95% confidence interval [CI] = 41.9 to 45.4) tested positive for a current mental disorder. Female sex (odds ratio [OR] 1.61, 95% CI = 1.25 to 2.06), having previous mental disorders (OR 2.58, 95% CI = 2.15 to 3.10), greater occupational exposure to patients with COVID-19 (OR 2.63, 95% CI = 1.98 to 3.51), having children or dependents (OR 1.35, 95% CI = 1.04 to 1.76 and OR 1.59, 95% CI = 1.20 to 2.11, respectively), or having an administrative job (OR 2.24, 95% CI = 1.66 to 3.03) were associated with a higher risk of any current mental disorder. Personal resilience was shown to be a protective factor. CONCLUSION: Almost half of primary care workers showed significant psychological distress. Strategies to support the mental health of primary care workers are necessary, including designing psychological support and resilience-building interventions based on risk factors identified.

Weld acoustic emission inspection of structural elements embedded in concrete.

After a catastrophic failure of the weld of the anchoring element of one cable in a stayed bridge, a non-destructive inspection was required to evaluate the weld condition of the 111 remaining anchoring elements to prevent future and similar failures. This examination was quite complicated since the anchoring elements are partially embedded in the reinforced concrete tower, and the weld is fully integrated into the concrete. Considering that direct access to the weld was not possible, acoustic emissions (AE) were a feasible alternative for these inspections. This study describes the inspection method, from laboratory tests simulating actual conditions for calibration to field tests for the method's tuning and evaluation. The AE inspection results are presented, and welds' condition is classified according to the acoustic energy, measured through a severity index and graded from a zonal intensity plot. Two structural elements were selected for concrete demolition to expose the weld for penetrant and ultrasonic inspections to correlate measurements of the actual condition of the welds and their defect size. Because of the analysis, welds are identified for immediate repair and the rest for AE monitoring to evaluate defect evolution through the increase of the severity index.

The Effort-Reward Model and Its Effect on Burnout Among Nurses in Ecuador.

Burnout has harmful consequences for individuals and organizations. The study of its antecedents can help us to manage and prevent it. This research aims to explore the role of the effort-reward imbalance (ERI) model as well as the mediation of the working experience in the burnout processes. For this purpose, we have conducted a study in 629 employees from two hospitals in the city of Guayaquil (Ecuador). For this study, the Spanish version of the Maslach Burnout Inventory was applied, as well as the ERI Questionnaire, along with other socio-demographical and occupational variables. A statistical analysis was performed with the obtained data, using structural equation models (SEMs). Results showed that employee effort has a stronger and statistically significant direct effect on emotional burnout, whereas the perception of the obtained reward also had this effect but indirectly in a negative sense, with job experience as a mediating variable.

Salud autopercibida en ancianos jóvenes españoles y portugueses tras la recesión según la Encuesta Europea de Salud: un estudio transversal / Self-perceived health in Spanish and Portuguese young seniors after the great recession according to the European Health Survey: A cross-sectional study

Objetivo: Describir el estado de salud autopercibida (SAP) en la población de entre 65 y 74años de España y Portugal y analizar los factores asociados a buena salud medidos en la Encuesta Europea de Salud (European Health Interview Survey [EHIS]) de 2014. Diseño: Análisis retrospectivo de datos secundarios provenientes de la EHIS de 2014. Ámbito: Comunitario. Participantes: Se analizaron todos los individuos entre 65 y 74años de España y Portugal encuestados con datos disponibles. Mediciones principales: Se recogió la SAP en cinco niveles (de muy buena a muy mala) con escala Likert, variables sociodemográficas, clínicas, enfermedades crónicas, estilos de vida y utilización de recursos sanitarios. Se realizó un análisis multivariante mediante un modelo de regresión logística (muy buena/buena SAP vs resto) para estudiar el efecto del país ajustado por los diferentes factores sociodemográficos, clínicos y/o de estilos de vida usando estimadores robustos. Resultados: Se estudió un total de 5.977 sujetos, de los cuales el 42,6% eran hombres y el 57,5% mujeres. La buena SAP varió entre países (52,9% España vs. 19% Portugal; p<0,001) y sexos (44% hombres vs. 31,3% mujeres; p<0,001). Ambos países presentaron elevada multimorbilidad (64,7% España vs. Portugal 76,3%; p<0,001), aunque la distribución de enfermedades crónicas no difirió, salvo depresión (13,2% España vs. 20,3% Portugal; p<0,001). Entre los factores individuales relacionados con la buena SAP encontramos la nacionalidad española (OR: 4,52; IC95%: 4,05-5,04), el sexo masculino (OR: 1,10; IC95%: 1,01-2,21), haber completado la enseñanza primaria (OR: 1,28; IC95%: 1,24-1,31) o superior (OR: 2,43; IC95%: 1,14-5,17) frente a estudios primarios incompletos, y realizar ejercicio físico dos o más días por semana (OR: 1,87; IC95%: 1,39-2,5). Factores que afectan negativamente la SAP fueron la presencia de multimorbilidad (OR: 0,19; IC95%: 0,12-0,31) y la depresión (OR: 0,32; IC95%: 0,25-0,41).(AU)

Objective: The aim of this study is to describe self-perceived health (SPH) in Spanish and Portuguese population aged between 65 and 74years old and to analyze other associated factors measured in the European Health Interview Survey (EHIS) in 2014. Design: Retrospective secondary data analysis from EHIS 2014. Setting: Community based. Participants: Young seniors, people aged 65-74years old surveyed and with available data from two countries. Main measurements: For each country and sex, SPH, sociodemographic variables, clinical chronic conditions, lifestyles and utilization of health care resources were described. A multiple logistic regression (very good or good SPH versus remaining levels) with robust estimators was used to assess the country effect adjusted by sociodemographic factors, clinical factors and/or lifestyles. Results: Good SPH showed variation by country (52.9% Spain vs. 19% Portugal; P<.001) and gender (44% men vs. 31.3% women; P<.001). Both countries had high prevalence of multimorbidity (64.7% Spain vs. 76.3% Portugal; P<.001) and the distribution of chronic diseases was similar with the only exception of depression (13.2% Spain vs. 20.3% Portugal; P<.001). Regarding individual factors related with good SPH we found Spanish nationality (OR: 4.52; 95%CI: 4.05-5.04), male gender (OR: 1.10; 95%CI: 1.101-2.21), education level, completing primary school (OR: 1.28; 95%CI: 1.24-1.31) or achieving tertiary level (OR: 2.43; 95%CI: 1.14-5.17) and physical activity of two or more days per week (OR: 1.87; 95%CI: 1.39-2.5). Factors with a negative impact on SPH were multimorbidity (OR: 0.19; 95%CI: 0.12-0.31) and depression (OR: 0.32; 95%CI: 0.25-0.41). Discussion: Good SPH is higher in Spanish young seniors compared to Portuguese. Having higher level of education achieved and practicing regular physical exercise were two most important factors increasing good SPH.(AU)

Effectiveness of a home-based nursing support and cognitive restructuring intervention on the quality of life of family caregivers in primary care: A pragmatic cluster-randomized controlled trial.

BACKGROUND: Caregivers of patients with chronic conditions or disability experience fatigue, burden and poor health-related quality of life. There is evidence of the effectiveness of support interventions for decreasing this impact. However, little is known about the benefits of home-based nursing intervention in primary health care. OBJECTIVES: To evaluate the effectiveness of a home-based, nurse-led-intervention (CuidaCare) on the quality of life of caregivers of individuals with disabilities or chronic conditions living in the community, measured at 12-month follow-up. METHODS: A pragmatic, two-arm, cluster-randomized controlled trial with a 1-year follow-up period was performed between June 2013 and December 2015. Consecutive caregivers aged 65 years or older, all of whom assumed the primary responsibility of caring for people with disabling conditions for at least 6 months a year, were recruited from 22 primary health care centers. Subsequently, 11 centers were randomly assigned to usual care group, and 11 were assigned to the intervention group. The caregivers in the intervention group received the usual care and additional support (cognitive restructuring, health education and emotional support). The primary outcome was quality of life, assessed with the EQ-5D instrument (visual analog scale and utility index score); the secondary outcome variables were perception of burden, anxiety, and depression. Data were collected at baseline, at the end of the intervention, and at the 6- and 12-month follow-up visits. We analyzed the primary outcome as intention-to-treat, and missing data were added using the conditional mean single imputation method. RESULTS: A total of 224 caregivers were included in the study (102 in the intervention group and 122 in the usual care group). Generalized Estimating Equation models showed that the CuidaCare intervention was associated with a 5.46 point (95% CI: 2.57; 8.35) change in the quality of life, as measured with the visual analog scale adjusted for the rest of the variables at 12 months. It also produced an increase of 0.04 point (95% CI: 0.01; 0.07) in the utilities. No statistically significant differences were found between the two groups at 12 months with respect to the secondary outcomes. CONCLUSIONS: The findings suggest that incorporating a home-based, nurse-led-intervention for caregivers into primary care can improve the health-related quality of life of caregivers of patients with chronic or disabling conditions.

Drug interactions detected by a computer-assisted prescription system in primary care patients in Spain: MULTIPAP study.

BACKGROUND: Drug interactions increase the risk of treatment failure, intoxication, hospital admissions, consultations and mortality. Computer-assisted prescription systems can help to detect interactions. OBJECTIVES: To describe the drug-drug interaction (DDI) and drug-disease interaction (DdI) prevalence identified by a computer-assisted prescription system in patients with multimorbidity and polypharmacy. Factors associated with clinically relevant interactions were analysed. METHODS: Observational, descriptive, cross-sectional study in primary health care centres was undertaken in Spain. The sample included 593 patients aged 65-74 years with multimorbidity and polypharmacy participating in the MULTIPAP Study, recruited from November 2016 to January 2017. Drug interactions were identified by a computer-assisted prescription system. Descriptive, bivariate, and multivariate analyses with logistic regression models and robust estimators were performed. RESULTS: Half (50.1% (95% CI 46.1-54.1)) of the patients had at least one relevant DDI and 23.9% (95% CI 18.9-25.6) presented with a DdI. Non-opioid-central nervous system depressant drug combinations and benzodiazepine-opioid drug combinations were the two most common clinically relevant interactions (10.8% and 5.9%, respectively). Factors associated with DDI were the use of more than 10 drugs (OR 11.86; 95% CI 6.92-20.33) and having anxiety/depressive disorder (OR 1.98; 95% CI 1.31-2.98). Protective factors against DDI were hypertension (OR 0.62; 95% CI 0.41-0.94), diabetes (OR 0.57; 95% CI 0.40-0.82), and ischaemic heart disease (OR 0.43; 95% CI 0.25-0.74). CONCLUSION: Drug interactions are prevalent in patients aged 65-74 years with multimorbidity and polypharmacy. The clinically relevant DDI frequency is low. The number of prescriptions taken is the most relevant factor associated with presenting a clinically relevant DDI.

[Self-perceived health in Spanish and Portuguese young seniors after the great recession according to the European Health Survey: A cross-sectional study]. / Salud autopercibida en ancianos jóvenes españoles y portugueses tras la recesión según la Encuesta Europea de Salud: un estudio transversal.

OBJECTIVE: The aim of this study is to describe self-perceived health (SPH) in Spanish and Portuguese population aged between 65 and 74years old and to analyze other associated factors measured in the European Health Interview Survey (EHIS) in 2014. DESIGN: Retrospective secondary data analysis from EHIS 2014. SETTING: Community based. PARTICIPANTS: Young seniors, people aged 65-74years old surveyed and with available data from two countries. MAIN MEASUREMENTS: For each country and sex, SPH, sociodemographic variables, clinical chronic conditions, lifestyles and utilization of health care resources were described. A multiple logistic regression (very good or good SPH versus remaining levels) with robust estimators was used to assess the country effect adjusted by sociodemographic factors, clinical factors and/or lifestyles. RESULTS: Good SPH showed variation by country (52.9% Spain vs. 19% Portugal; P<.001) and gender (44% men vs. 31.3% women; P<.001). Both countries had high prevalence of multimorbidity (64.7% Spain vs. 76.3% Portugal; P<.001) and the distribution of chronic diseases was similar with the only exception of depression (13.2% Spain vs. 20.3% Portugal; P<.001). Regarding individual factors related with good SPH we found Spanish nationality (OR: 4.52; 95%CI: 4.05-5.04), male gender (OR: 1.10; 95%CI: 1.101-2.21), education level, completing primary school (OR: 1.28; 95%CI: 1.24-1.31) or achieving tertiary level (OR: 2.43; 95%CI: 1.14-5.17) and physical activity of two or more days per week (OR: 1.87; 95%CI: 1.39-2.5). Factors with a negative impact on SPH were multimorbidity (OR: 0.19; 95%CI: 0.12-0.31) and depression (OR: 0.32; 95%CI: 0.25-0.41). DISCUSSION: Good SPH is higher in Spanish young seniors compared to Portuguese. Having higher level of education achieved and practicing regular physical exercise were two most important factors increasing good SPH.

[Evidence-Based Psychological Treatments for Adults: A Selective Review]

Evidence-Based Psychological Treatments for Adults: A Selective Review. BACKGROUND: Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults. METHOD: Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders. RESULTS: The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation. CONCLUSIONS: Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help.