Incidence, treatment, and factors associated with survival of out-of-hospital cardiac arrest attended by Spanish emergency services: report from the Out-of-Hospital Spanish Cardiac Arrest Registry for 2022. / Incidencia, tratamiento y factores asociados con la supervivencia de la parada cardiaca extrahospitalaria atendida por los servicios de emergencias en España: informe 2022 del registro OHSCAR.

SUMMARY: Out-of-hospital cardiac arrest is a serious public health problem worldwide. The annual incidence is estimated at around 400 000 cases in Europe and the United States, and survival rates scarcely reach 10%. However, there is considerable variation between countries and even between regions that share a similar health care system within a single country. Information recorded by the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) provides information on care provided by emergency ambulance services, final health outcomes after cardiac arrest cases (including variations), the possibility of organ donation, and the impact of the COVID-19 pandemic. This paper presents the OHSCAR report for Spanish emergency services for the year 2022.

RESUMEN: La parada cardiorrespiratoria extrahospitalaria (PCREH) es un grave problema de salud pública mundial, con una incidencia anual estimada entorno a entorno a los 350.000 y 400.000 casos de PCERH en Europa y Estados Unidos, respectivamente. La supervivencia final se sitúa en porcentajes que apenas alcanzan el 10%, aunque existe una importante variabilidad entre países e incluso entre regiones del mismo país con modelos de atención similares. En España, el Registro Español de Parada Cardiaca Extrahospitalaria (acrónimo OHSCAR) ha ofrecido información sobre la asistencia a la PCRE prestada por los servicios de emergencias (SEM) y sus resultados finales en salud, así como sobre variabilidad, posibilidades de programas de donación o impacto de la pandemia COVID-19. A continuación se presenta el informe OHSCAR correspondiente a la asistencia a la PCRE por los SEM españoles durante el año 2022.

Agresiones externas al personal sanitario de un servicio público de salud (2008-2012) / Work-related violence among public health professionals (2008-2012)

Objetivo. Describir los tipos y factores asociados a las agresiones de usuarios o acompañantes a los profesionales en el Servicio Navarro de Salud-Osasunbidea, desde agosto del 2008 a diciembre del 2012. Método. Estudio descriptivo de las agresiones externas registradas. La variable resultado fue el tipo de agresión (agresión física y/o verbal). Las características del personal agredido y de la agresión se describieron mediante frecuencias y porcentajes. La asociación entre el tipo de agresión y las variables estudiadas se valoró mediante el Chi-cuadrado. Se estimaron tasas de incidencias de agresiones por 100 trabajadores-año y se compararon mediante la razón de tasas. Resultados. Se notificaron 684 agresiones (45,4% fueron verbales). Salud Mental fue el servicio donde más agresiones se registraron (51,9%) predominando las físicas. Las verbales destacaron en Atención Primaria y Especializada. Se determinó una mayor tasa de incidencia de agresiones en celadores (4,5 por 100 trabajadores-año), Salud Mental (5,5 por 100 trabajadores-año) y menores de 35 años (5,9 por 100 trabajadores-año). La tasa fue la misma en hombres y mujeres (1,6 por 100 trabajadores-año) aunque estratificando por categoría profesional las mujeres que presentaron mayor riesgo fueron facultativas y administrativas y los hombres, enfermeros y celadores. Conclusiones. Los factores asociados a los episodios de violencia externa en trabajadores como tipo de servicio y categorías profesionales deben considerarse en el diseño de medidas preventivas

Objective. To describe the types of work-related violence and associated factors among professionals of the Navarra Health Service-Osasunbidea from August 2008 to December 2012. Method. This was a descriptive study of reported work-related violence incidents. The outcome variable was the type of violence (physical and/or verbal assault). The characteristics of the victims and the aggression were described using frequencies and percentages. Associations between the type of violence and the independent variables were evaluated using chi-square statistics. Work-related violence incidence rates per 100 worker-years were estimated and rates compared using the rate ratio. Results. 684 attacks were reported (45.4% were verbal). Mental health was the service where most attacks were recorded (51.9%), predominantly physical. Verbal aggression were most common in primary and specialty care. The incidence of aggressions were highest among orderlies (4.5 per 100 worker-years), mental health (5,5 per 100 worker-years) and professionals under 35 years of age (5.9 per 100 worker-years). Rates were similar in men and women (1.6 per 100 workeryears). However, when stratified by professional category, women at the greatest risk were female physicians and administrative assistants; among the men, risk was greatest among male nurses and orderlies. Conclusions. Factors associated with work-related violence, such as location and professional category, should be considered when designing preventive measures

[Work-related violence among public health professionals (2008-2012)]. / Agresiones externas al personal sanitario de un servicio público de salud (2008-2012).

OBJECTIVE: To describe the types of work-related violence and associated factors among professionals of the Navarra Health Service-Osasunbidea from August 2008 to December 2012. METHOD: This was a descriptive study of reported work-related violence incidents. The outcome variable was the type of violence (physical and/or verbal assault). The characteristics of the victims and the aggression were described using frequencies and percentages. Associations between the type of violence and the independent variables were evaluated using chi-square statistics. Work-related violence incidence rates per 100 worker-years were estimated and rates compared using the rate ratio. RESULTS: 684 attacks were reported (45.4%were verbal).Mental health was the service where most attacks were recorded (51.9%), predominantly physical. Verbal aggression were most common in primary and specialty care. The incidence of aggressions were highest among orderlies (4.5 per 100 worker-years), mental health (5,5 per 100 worker-years) and professionals under 35 years of age (5.9 per 100 worker-years). Rates were similar in men and women (1.6 per 100 workeryears). However, when stratified by professional category, women at the greatest risk were female physicians and administrative assistants; among the men, risk was greatest among male nurses and orderlies. CONCLUSIONS: Factors associated with work-related violence, such as location and professional category, should be considered when designing preventive measures.

OBJETIVO: Describir los tipos y factores asociados a las agresiones de usuarios o acompañantes a los profesionales en el Servicio Navarro de Salud-Osasunbidea, desde agosto del 2008 a diciembre del 2012. MÉTODO: Estudio descriptivo de las agresiones externas registradas. La variable resultado fue el tipo de agresión (agresión física y/o verbal). Las características del personal agredido y de la agresión se describieron mediante frecuencias y porcentajes. La asociación entre el tipo de agresión y las variables estudiadas se valoró mediante el Chi-cuadrado. Se estimaron tasas de incidencias de agresiones por 100 trabajadores-año y se compararon mediante la razón de tasas. RESULTADOS: Se notificaron 684 agresiones (45,4% fueron verbales). Salud Mental fue el servicio donde más agresiones se registraron (51,9%) predominando las físicas. Las verbales destacaron en Atención Primaria y Especializada. Se determinó una mayor tasa de incidencia de agresiones en celadores (4,5 por 100 trabajadores-año), Salud Mental (5,5 por 100 trabajadores-año) y menores de 35 años (5,9 por 100 trabajadores-año). La tasa fue la misma en hombres y mujeres (1,6 por 100 trabajadores-año) aunque estratificando por categoría profesional las mujeres que presentaron mayor riesgo fueron facultativas y administrativas y los hombres, enfermeros y celadores. CONCLUSIONES: Los factores asociados a los episodios de violencia externa en trabajadores como tipo de servicio y categorías profesionales deben considerarse en el diseño de medidas preventivas.

Análisis y evaluación de resultados tras la implantación de un programa de prescripción electrónica asistida en un hospital de tercer nivel / Analysis and evaluation of results following the implementation of a programme of e-prescribing in a tertiary hospital

Introducción: la Prescripción Electrónica Asistida (PEA), constituye en la actualidad una herramienta útil en el proceso de hospitalización. La supresión de la prescripción y/o transcripción manuscrita, ha conseguido minimizar los errores relacionados con la medicación, mitigando la constante preocupación que supone la seguridad del paciente. Objetivo: analizar los datos de intervención farmacéutica registrados tras la implantación de un software de prescripción electrónica y la seguridad que confiere al usuario. Material y método: estudio retrospectivo de cinco meses de duración, en el que se revisaron las historias clínicas electrónicas de prescripción, describiendo los errores de medicación detectados y el número de intervenciones farmacéuticas realizadas. Resultados: sobre un total de 27.533 validaciones, fueron realizadas 4.917 intervenciones farmacéuticas (IF), lo que supone 32,78 errores de medicación/día y 0,95 errores/paciente

Introduction: the Electronically Assisted Prescription (EAP) is now a useful tool in the process of hospitalization. The removal of the prescription or transcript handwritten, has managed to minimize errors related to medication, mitigating the constant concern involving the safety of the patient. Objective: to analyze data pharmaceutical intervention reported following implementation of a software for e-prescribing and the security that gives the user. Materials and methods: retrospective study of five months duration, which reviewed the electronic medical records of prescription, describing medication errors that are detected and the number of pharmaceutical interventions carried out. Results: out of a total of 27.533 validations, were performed 4.917 pharmaceutical interventions (IF), which represents 32.78 medication errors per day and 0.95 errors per patient

[Morbidity and drug consumption. Comparison of results between the National Health Survey and electronic medical records]. / Morbilidad y consumo de fármacos. Comparación de resultados entre la Encuesta Nacional de Salud y los registros electrónicos.

OBJECTIVE: To compare the prevalence of disease and drug consumption obtained by using the National Health Survey (NHS) with the information provided by the electronic medical records (EMR) in primary health care and the Pharmaceutical Consumption Registry in Aragon (Farmasalud) in the adult population in the province of Zaragoza. METHODS: A cross-sectional study was performed to compare the prevalence of diseases in the NHS-2006 and in the EMR. The prevalence of drug consumption was obtained from the NHS-2006 and Farmasalud. Estimations using each database were compared with their 95% confidence intervals (95% CI) and the results were stratified by gender and age groups. The comparability of the databases was tested. RESULTS: According to the NHS, a total of 81.8% of the adults in the province of Zaragoza visited a physician in 2006. According to the EMR, 61.4% of adults visited a primary care physician. The most prevalent disease in both databases was hypertension (NHS: 21.5%, 95% CI: 19.4-23.9; EMR: 21.6%, 95% CI: 21.3-21.8). The greatest differences between the NHS and EMR was observed in the prevalence of depression, anxiety, and other mental illnesses (NHS: 10.9%; EMR: 26.6%). The most widely consumed drugs were analgesics The prevalence of drug consumption differed in the two databases, with the greatest differences being found in pain medication (NHS: 23.3%; Farmasalud: 63.8%) and antibiotics (NHS: 3.4%; Farmasalud: 41.7%). These differences persisted after we stratified by gender and were especially important in the group aged more than 75 years. CONCLUSIONS: The prevalence of morbidity and drug consumption differed depending on the database employed. The use of different databases is recommended to estimate real prevalences.

Risk of advanced proximal neoplasms according to distal colorectal findings: comparison of sigmoidoscopy-based strategies.

BACKGROUND: Screening for colorectal cancer with sigmoidoscopy benefits from the fact that distal findings predict the risk of advanced proximal neoplasms (APNs). This study was aimed at comparing the existing strategies of postsigmoidoscopy referral to colonoscopy in terms of accuracy and resources needed. METHODS: Asymptomatic individuals aged 50-69 years were eligible for a randomized controlled trial designed to compare colonoscopy and fecal immunochemical test. Sigmoidoscopy yield was estimated from results obtained in the colonoscopy arm according to three sets of criteria of colonoscopy referral (from those proposed in the UK Flexible Sigmoidoscopy, Screening for COlon REctum [SCORE], and Norwegian Colorectal Cancer Prevention [NORCCAP] trials). Advanced neoplasm detection rate, sensitivity, specificity, and number of individuals needed to refer for colonoscopy to detect one APN were calculated. Logistic regression analysis was performed to identify distal findings associated with APN. All statistical tests were two-sided. RESULTS: APN was found in 255 of 5059 (5.0%) individuals. Fulfillment of UK (6.2%), SCORE (12.0%), and NORCCAP (17.9%) criteria varied statistically significantly (P < .001). The NORCCAP strategy obtained the highest sensitivity for APN detection (36.9%), and the UK approach reached the highest specificity (94.6%). The number of individuals needed to refer for colonoscopy to detect one APN was 6 (95% confidence interval [CI] = 4 to 7), 8 (95% CI = 6 to 9), and 10 (95% CI = 8 to 12) when the UK, SCORE, and NORCCAP criteria were used, respectively. The logistic regression analysis identified distal adenoma ≥10 mm (odds ratio = 3.77; 95% CI = 2.52 to 5.65) as the strongest independent predictor of APN. CONCLUSIONS: Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.

Prescripción extrahospitalaria de antibióticos en Aragón y sus diferencias por género y edad / Outpatient antibiotic prescription in Aragón and the differences by gender and age

Introducción: El objetivo de este estudio es describir la prescripción de antibióticos en atención extrahospitalaria y su patrón de consumo por subgrupos, analizar los patrones de utilización por edad y sexo e identificar pacientes hiperconsumidores. Métodos Estudio observacional retrospectivo en el que se estimó la proporción de habitantes de Aragón que habían sido tratados con antibióticos en 2008. Los datos se obtuvieron del Sistema de Información de Consumo Farmacéutico de Aragón, que recoge las recetas dispensadas en oficinas de farmacia. Se calcularon la tasa de habitantes expuestos a tratamiento antibiótico y la dosis diaria definida (DDD) por mil habitantes/día (DHD).Resultados La tasa de prescripción de antibióticos en 2008 en Aragón fue de 339,81 por 1.000 habitantes (303,54 por 1.000 en hombres y 375,34 por 1.000 en mujeres). La prescripción extrahospitalaria de antibióticos en Aragón fue de 23,72 DHD. La frecuencia de consumo presenta diferencias importantes en función de la edad y el sexo. En los niños de 0 a 4 años se observa la mayor tasa de utilización de antibióticos, y las mujeres, en general, presentan una mayor frecuencia de consumo que los hombres. Las penicilinas son el subgrupo de antibióticos más utilizado en todos los grupos de edad, excepto en los mayores de 80 años, en quienes son desplazadas por las quinolonas. El mayor porcentaje de pacientes considerados hiperconsumidores en adultos (más de 60 DDD de antibióticos al año) tuvo lugar en el grupo entre 60 y 80 años. Conclusión Se observó una elevada prescripción de antibióticos en Aragón, siendo llamativo el elevado consumo en los niños más pequeños, y las diferencias entre mujeres y hombres (AU)

Background: The objective of the study is to describe the use of antibiotics among outpatients, the pattern of sub-group prescribing, as well as to analyse age- and gender-specific patterns of use, and to identify high users. Methods: A retrospective, observational study was designed, in which the rate of patients treated with antibiotics in Aragon (Spain) in 2008 was calculated. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions in Aragon in 2008. Defined Daily Dose (DDD) per 1000 inhabitants per day (DID) was calculated, and the number of patients who had received an antibacterial drug was analysed. Results: The antibiotic prescription rate in 2008 in Aragón was 339.81 per 1000 inhabitants (303.54and 375.34 per 1000 for men and women, respectively). The DID was 23.72. Population prevalence of antimicrobial use changed markedly between different age groups and between genders. Children (0-4 years) had the highest rate. Females, in general, used antibiotics more than males. Penicillins was the most used antibacterial group in all age groups, except for people of advanced age (>80 years), where quinolones were the most frequently used. Most of the individuals defined as high users (using more than60 DDDs/year) were in the 60-80 years age group. Conclusion: We observed a high antibiotic prescription rate in Aragon, particularly in children. There are differences between men and women in the use of antibiotics (AU)

[Outpatient antibiotic prescription in Aragón and the differences by gender and age]. / Prescripción extrahospitalaria de antibióticos en Aragón y sus diferencias por género y edad.

BACKGROUND: The objective of the study is to describe the use of antibiotics among outpatients, the pattern of sub-group prescribing, as well as to analyse age- and gender-specific patterns of use, and to identify high users. METHODS: A retrospective, observational study was designed, in which the rate of patients treated with antibiotics in Aragon (Spain) in 2008 was calculated. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions in Aragon in 2008. Defined Daily Dose (DDD) per 1000 inhabitants per day (DID) was calculated, and the number of patients who had received an antibacterial drug was analysed. RESULTS: The antibiotic prescription rate in 2008 in Aragón was 339.81 per 1000 inhabitants (303.54 and 375.34 per 1000 for men and women, respectively). The DID was 23.72. Population prevalence of antimicrobial use changed markedly between different age groups and between genders. Children (0-4 years) had the highest rate. Females, in general, used antibiotics more than males. Penicillins was the most used antibacterial group in all age groups, except for people of advanced age (>80 years), where quinolones were the most frequently used. Most of the individuals defined as high users (using more than 60 DDDs/year) were in the 60-80 years age group. CONCLUSION: We observed a high antibiotic prescription rate in Aragon, particularly in children. There are differences between men and women in the use of antibiotics.

[Variations in the prescription of antibiotics among primary care areas in the autonomous region of Aragon, Spain]. / Variabilidad de la prescripción de antibióticos en atención primaria de los sectores sanitarios de Aragón.

BACKGROUND: Resistance to antibacterial drugs can be contained by judicious utilization, so we must know about its use. The objective is to describe the prevalence of antibiotic consumption and the variability in the use of antibiotics among outpatients in the different health areas of Aragon. METHODS: Study of the prescription of antibiotics in the health areas of Aragon in 2008. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions. Prescription rates per 1000 individuals adjusted by sex and age were calculated using a direct and indirect standardization method. The subgroups utilization were calculated in Defined Daily Dose per 1000 inhabitants per day (DID). In the variation analysis were used: extremal quotient (EQ), coefficient of variation (CV), weighted coefficient of variation (CVw). RESULTS: The adjusted rate of antibiotic varied between 279,8 and 382 per 1000 inhabitants, showing a CVw=0,12. The utilization rate in women was 364.9 per 1,000 and in men 300.0 per 1,000. Cephalosporins have a EQ=2,42 and CVw=0,37; and quinolones have EQ=1,84 and CVw=0,22. CONCLUSIONS: The utilization rate was higher in women than men. The higher variability in the prescription of antibiotics among health areas in Aragon was in cephalosporins and quinolones.

Efectividad y seguridad de ranibizumab en degeneración macular neovascular asociada a la edad / Assessment of the effectiveness and safety of ranibizumab in neovascular agerelated macular degeneration

Fundamento y objetivos: La degeneración macular asociada a la edad (DMAE) neovascular es una enfermedad degenerativa y crónica. Los tratamientos actuales sólo han demostrado ralentizar la progresión de la DMAE. El objetivo del estudio es evaluar la efectividad y seguridad de ranibizumab en una serie de pacientes, así como describir sus características demográficas y clínicas. Pacientes y método: Se realizó un estudio observacional y retrospectivo, incluyendo todos los pacientes que iniciaron tratamiento desde el 1-12-2006 hasta el 31-12-2008, realizándose el seguimiento hasta el 31-03-2009. Se realizó un análisis bivariante y modelos de regresión logística para analizar la influencia de factores demográficos y clínicos en la efectividad y en la durabilidad del tratamiento. Se recogieron las reacciones adversas descritas en las historias clínicas para evaluar la seguridad.Resultados: Se incluyeron 112 pacientes con una media (DE) de edad de 77,7 (6,0) años. La media de durabilidad del tratamiento fue de 18,2 meses, siendo superior en el grupo de pacientes que iniciaron tratamiento con agudeza visual (AV) > 0,1 (p<0,001). Ranibizumab mantenía la AV por encima de los valores basales hasta los 18 meses. Ninguna de las variables estudiadas se asoció con la efectividad del tratamiento. La agudeza visual inicial influía en la duración del tratamiento, siendo superior en el grupo de pacientes con AV > 0,1.Conclusiones: Ranibizumab parece ser efectivo hasta los 18 meses. Un diagnóstico precoz de DMAE permitiría un inicio del tratamiento más temprano cuando los pacientes presentan valores superiores de AV, optimizando los beneficios del tratamiento. Ranibizumab fue bien tolerado y seguro en la mayoría de los pacientes (AU)

Background and objectives: Neovascular Age Related Macular Degeneration (ARMD) is a chronic and degenerative disease. Current treatment options are limited and have shown to slow diseaseprogression. The aim of this study was to assess Ranibizumab effectiveness and safety and to describe patients’ demographic and clinical characteristics. Patients and method: We conducted a retrospective observational study including all patients who had started treatment between 1/12/2006 and 31/12/2008, and were followed up until31/03/2009. A bivariate analysis on months 4, 12 and 18 and two logistic regression models were performed to analyze the influence of demographic and clinical factors on the effectiveness and durability of treatment. Adverse reactions were collected as described in themedical records to assess safetyResults: A total of 126 eyes of 112 patients were recruited. The mean age was 77.7 ( 6.0) years. The meandurability of treatment was 18.2 months, and it was higher in the group of patients who started treatment with visual acuity (VA) > 0.1 (p < 0.001). Ranibizumab therapy maintained AV over baseline at 18 months.None of the studied variables showed any influence on treatment effectiveness. However, baseline visual acuity influenced on reatment duration, being higher in the group of patients with AV > 0.1.Conclusions: Ranibizumab was shown to be effective until 18months. Early diagnosis of AMD could lead to an earlier treatment start, when patients present a higher AV, in order to optimize the benefits of treatment. Ranibizumab was well tolerated and safe in most patients (AU)

[Assessment of the effectiveness and safety of ranibizumab in neovascular age-related macular degeneration]. / Efectividad y seguridad de ranibizumab en degeneración macular neovascular asociada a la edad.

BACKGROUND AND OBJECTIVES: Neovascular Age Related Macular Degeneration (ARMD) is a chronic and degenerative disease. Current treatment options are limited and have shown to slow disease progression. The aim of this study was to assess Ranibizumab effectiveness and safety and to describe patients' demographic and clinical characteristics. PATIENTS AND METHOD: We conducted a retrospective observational study including all patients who had started treatment between 1/12/2006 and 31/12/2008, and were followed up until 31/03/2009. A bivariate analysis on months 4, 12 and 18 and two logistic regression models were performed to analyze the influence of demographic and clinical factors on the effectiveness and durability of treatment. Adverse reactions were collected as described in the medical records to assess safety. RESULTS: A total of 126 eyes of 112 patients were recruited. The mean age was 77.7 (± 6.0) years. The mean durability of treatment was 18.2 months, and it was higher in the group of patients who started treatment with visual acuity (VA) > 0.1 (p<0.001). Ranibizumab therapy maintained AV over baseline at 18 months. None of the studied variables showed any influence on treatment effectiveness. However, baseline visual acuity influenced on treatment duration, being higher in the group of patients with AV > 0.1. CONCLUSIONS: Ranibizumab was shown to be effective until 18 months. Early diagnosis of AMD could lead to an earlier treatment start, when patients present a higher AV, in order to optimize the benefits of treatment. Ranibizumab was well tolerated and safe in most patients.

MYB46 modulates disease susceptibility to Botrytis cinerea in Arabidopsis.

In this study, we show that the Arabidopsis (Arabidopsis thaliana) transcription factor MYB46, previously described to regulate secondary cell wall biosynthesis in the vascular tissue of the stem, is pivotal for mediating disease susceptibility to the fungal pathogen Botrytis cinerea. We identified MYB46 by its ability to bind to a new cis-element located in the 5' promoter region of the pathogen-induced Ep5C gene, which encodes a type III cell wall-bound peroxidase. We present genetic and molecular evidence indicating that MYB46 modulates the magnitude of Ep5C gene induction following pathogenic insults. Moreover, we demonstrate that different myb46 knockdown mutant plants exhibit increased disease resistance to B. cinerea, a phenotype that is accompanied by selective transcriptional reprogramming of a set of genes encoding cell wall proteins and enzymes, of which extracellular type III peroxidases are conspicuous. In essence, our results substantiate that defense-related signaling pathways and cell wall integrity are interconnected and that MYB46 likely functions as a disease susceptibility modulator to B. cinerea through the integration of cell wall remodeling and downstream activation of secondary lines of defense.

Desigualdades geográficas en mortalidad e incidencia por cáncer de laringe en varones: factores socioeconómicos y ambientales / Geographical inequalities in mortality and incidence in larynx cancer in men: socioeconomic and environmental factors

Fundamento: Diversos estudios sugieren la relación entre menor nivel socioeconómico y factores ambientales con mayor riesgo de cáncer. El objetivo del trabajo es identificar desigualdades geográficas en mortalidad e incidencia por cáncer de laringe (CL) en varones y su asociación con factores de privación y ambientales en el marco del proyecto MEDEA. Métodos: Estudio ecológico cuya población de referencia fueron los hombres residentes en el municipio de Zaragoza. El periodo de estudio fue 1996-2003. Las defunciones fueron obtenidas del Registro de Mortalidad de Aragón, los casos incidentes del Registro Poblacional de Cáncer de Zaragoza y los datos socioeconómicos del Censo de 2001. Se utilizó la base de datos del Registro Europeo de Emisiones Contaminantes en la localización de posibles industrias contaminantes. Para cada sección censal (SC) se obtuvo un índice de privación mediante análisis de componentes principales. Se obtuvieron las Razones de Mortalidad e Incidencia Estandarizadas suavizadas aplicando metodología bayesiana. Resultados: Se analizaron 211 defunciones y 569 casos incidentes, con SC conocida, que correspondieron al 95% del total de casos registrados de mortalidad y el 97,8% de incidencia. Las SC que se encontraban en el cuartil superior, mayor índice de privación, tuvieron significativamente mayor riesgo, tanto de mortalidad (2,74 veces) como de incidencia (1,66 veces). Sin embargo no se encontró asociación estadísticamente significativa con los indicadores ambientales utilizados. Conclusiones: Las SC con menor nivel económico presentan mayor riesgo de mortalidad e incidencia por CL. La posible exposición a focos industriales contaminantes no explica la variabilidad geográfica observada(AU)

Background: Several studies suggest the relationship between lower socioeconomic status and environmental factors with increased risk of cancer. Within the framework of the MEDEA project, this work aims to identify geographic inequalities in larynx cancer (LC) mortality and incidence in men and its association with deprivation and environmental factors. Methods: Ecological study having as reference population men living in the city of Zaragoza. The study period was 1996-2003. The deaths were obtained from the Mortality Registry of Aragon, the incident cases from the Cancer Registry of Zaragoza and the socioeconomic data from the 2001 Census. We used the European Pollutant Emission Register database to locate possible polluting industries. For each census tract (CT) a deprivation index was obtained using principal components analysis. Smoothed Standardized Mortality and Incidence ratios were also calculated using Bayesian methods. Results: We analysed 211 deaths and 569 incident cases with CT, corresponding to 95% of the total registered mortality cases and 97.8% incidence. The CTs in the highest quartile, highest deprivation index, had significantly higuer risk of mortality (2.74 times) as well as incidence (1.66 times) by LC. However, the environmental indicators have not been shown a statistically significance association. Conclusions: The CTs with the lowest socioeconomic status have higher risk of LC mortality and incidence. Nevertheless, the possible exposition to the polluting industrial focus does not explain the observed geographic variability(AU)

Respuesta: Transfusión sanguínea, infección nosocomial y trombosis venosa en pacientes de edad avanzada intervenidos de fractura de cadera / Reply: Blood transfusion, nosocomial infection and venous thrombosis in aged patients with surgery of hip fracture

No disponible

No disponible

[Geographical inequalities in mortality and incidence in larynx cancer in men: socioeconomic and environmental factors]. / Desigualdades geográficas en mortalidad e incidencia por cáncer de laringe en varones: factores socioeconómicos y ambientales.

BACKGROUND: Several studies suggest the relationship between lower socioeconomic status and environmental factors with increased risk of cancer. Within the framework of the MEDEA project, this work aims to identify geographic inequalities in larynx cancer (LC) mortality and incidence in men and its association with deprivation and environmental factors. METHODS: Ecological study having as reference population men living in the city of Zaragoza. The study period was 1996-2003. The deaths were obtained from the Mortality Registry of Aragon, the incident cases from the Cancer Registry of Zaragoza and the socioeconomic data from the 2001 Census. We used the European Pollutant Emission Register database to locate possible polluting industries. For each census tract (CT) a deprivation index was obtained using principal components analysis. Smoothed Standardized Mortality and Incidence ratios were also calculated using Bayesian methods. RESULTS: We analysed 211 deaths and 569 incident cases with CT, corresponding to 95% of the total registered mortality cases and 97.8% incidence. The CTs in the highest quartile, highest deprivation index, had significantly higuer risk of mortality (2.74 times) as well as incidence (1.66 times) by LC. However, the environmental indicators have not been shown a statistically significance association. CONCLUSIONS: The CTs with the lowest socioeconomic status have higher risk of LC mortality and incidence. Nevertheless, the possible exposition to the polluting industrial focus does not explain the observed geographic variability.

Vigilancia y Control de Staphylococcus aureus resistente a meticilina en hospitales españoles. Documento de consenso GEIH-SEIMC Y SEMPSPH / No disponible

Staphylococcus aureus resistente a meticilina (SARM) es un patógeno de gran trascendencia. Aunque existen numerosas guías para el control de este microorganismo, la aplicación de las medidas de control es heterogénea en los hospitales españoles. Este documento pretende ofrecer recomendaciones basadas en la evidencia, aplicables a nuestros centros, con el objetivo de reducir la transmisión de SARM en los centros sanitarios. Las recomendaciones se distribuyen en aspectos relacionados con la vigilancia, la detección activa de la colonización en pacientes y sanitarios, las medidas de control con los pacientes colonizados o infectados, el tratamiento de descolonización, la limpieza y desinfección ambiental, el consumo de antimicrobianos, las actuaciones en pacientes no hospitalizados y otros. Las medidas principales se refieren a una adecuada vigilancia, la higiene de manos, la detección activa de pacientes colonizados, el uso de precauciones de contacto y la limpieza ambiental (AU)

Methicillin-resistant Staphylococcus aureus (MRSA) is a very significant pathogen inside and outside hospitals. Although there are several guidelines with recommendations for the control of this microorganism, such measures are heterogeneously implemented in Spanish hospitals. The objective of this document is to provide evidence-based recommendation which are applicable to Spanish hospitals, with the aim to reduce the transmission of MRSA in our health care centers. The recommendations are classified in the following groups: surveillance, active surveillance of colonized patients and health are workers, control measures to be undertaken with colonized or infected patients, decolonization therapy, environmental cleaning and disinfection, antimicrobial consumption, actions with non-hospitalised patients, and other. The main recommended measures includes an appropriate surveillance, hand hygiene, implementation of active surveillance, contact precautions, and environmental cleaning (AU)

Opinión y participación de los médicos de familia de la Comunidad de Madrid en el programa regional de detección precoz de cáncer de mama en 2007 / Opinion and participation in the regional early breast cancer detection program in 2007 on the part of family physicians from a health district in the Autonomous Community of Madrid, Spain

Fundamento: La mamografía de cribado es el método más efectivo para la detección precoz de cáncer de mama. El objetivo de nuestro estudio es valorar el grado de conocimiento, opinión y participación de los médicos de familia de la Comunidad de Madrid en el programa de detección precoz de cáncer de mama. Métodos: La población de estudio fueron los médicos de familia del Area 7 de Madrid. Se diseñó un cuestionario anónimo autoadministrado, con 30 preguntas, agrupadas en características del médico, y opinión sobre los programas de detección precoz de cáncer de mama. Resultados: Se obtuvo un respuesta del 46%. El 94% de los médicos creen que es función suya informar a sus pacientes acerca de las actividades preventivas, incluidas el cribado de cáncer de mama, y el 95% creen que su consejo es útil para convencer a las mujeres a que se realicen una mamografía. El 72% cree que le falta información sobre el programa. Durante el periodo de realización de mamografías en su centro, el 24% pregunta siempre o casi siempre a las mujeres si tienen dudas o quieren más información, el 43% si les ha llegado la citación y el 95% les aconsejan que se realicen la mamografía. Conclusiones: Los médicos de familia tienen buena opinión del programa de detección precoz de cáncer de mama, y creen en la efectividad de su consejo para mejorar la participación en él. Refieren falta de información, y en pocas ocasiones informan a la mujer sobre el programa (AU)

Background: Mammogram screening is the most effective method for the early detection of breast cancer. The objective of this study is to evaluate the degree of knowledge, the opinion and the participation in the early breast cancer detection program on the part of the family physicians of the Autonomous Community of Madrid. Methods: The population studied was comprised of family physicians from Madrid Health District Seven. An anonymous, self-administered questionnaire comprised of 30 questions grouped into physician’s characteristics and opinion concerning the early breast cancer detection programs. Results: A total of 46% of the physicians replied. A total of 94% of the physicians believed that it is their duty to inform their patients concerning preventive activities, including breast cancer screening, and 95% believed their advice to be useful for convincing women to have a mammogram. A total of 72% believed information to be lacking on this program. During the time when mammograms are being taken at their centres, 24% of the physicians surveyed always or almost always ask the women if they have any doubts or would like further information, 43% having set up appointments for them and 95% advising them to have a mammogram taken. Conclusions: The family physicians have a good opinion of the early breast cancer detection program and feel their advice to be effective for improving the participation in the program. They report lack of information and inform women about the program to only a small degree (AU)

Variabilidad en la utilización de nuevos medicamentos en un área de Atención Primaria / Variability in the Use of New Drugs in a Primary Care District

Fundamento: La utilización de nuevos fármacos ha aumentadode forma importante en los últimos años. El objetivo de este trabajoes conocer la utilización de novedades farmacéuticas en un área desalud de Zaragoza, describir cuales son las más utilizadas y su evoluciónen el tiempo y analizar las características de los centros que seasocian con un mayor uso de estos medicamentos.Métodos: Se trata de un estudio descriptivo en el que se analizarontodas las dispensaciones de 50 nuevos principios activos comercializadosentre el 1-1-2000 y el 31-12-2003 en un área de salud. Secalculó el porcentaje de utilización de novedades durante el primeraño de su comercialización, en cada centro de atención primaria, y seanalizaron las características de los centros que se asociaban conmayor grado de innovación.Resultados: El 76% de los 50 nuevos fármacos comercializadoseran escasamente innovadores respecto a los ya existentes. Las dieznovedades más prescritas comenzaron a utilizarse en el primer cuatrimestretras su aparición en el mercado. El porcentaje de utilizaciónde novedades respecto al total de fármacos prescritos en los centrosde salud estudiados osciló entre el 0,3% y el 1,18%. En el análisisefectuado por centros, el «gasto por paciente» y las «consultas pormédico» se correlacionaron positivamente con un mayor uso demedicamentos nuevos, mientras que el porcentaje de pensionistaspresentó una relación inversa.Conclusiones: Existe una gran variabilidad en el porcentaje deutilización de novedades farmacológicas entre los centros de atenciónprimaria. Los centros con mayor número de consultas por facultativoson los que tienden a incorporar los nuevos medicamentos conmayor facilidad

Background: The use of new drugs has undergone a majorincrease in recent years. This study is aimed at ascertaining thedegree to which pharmaceutical novelties are being used in onehealthcare district in Zaragoza, describing which are those mostused and the trend thereof over the course of time in addition toanalyzing the characteristics of those centers associated with a greateruse of these drugs.Methods: A descriptive study analyzing all of the dispensationsof fifty new active ingredients marketed within the January 1, 2000 -December 31, 2003 period in one healthcare district. The percentageof use of novelties throughout the first year these drugs were marketedat each primary care center was calculated, the characteristicsof those centers associated with a greater degree of innovationhaving been analyzed.Results: Seventy-six percent of the fifty new drugs marketedwere barely innovative in comparison to the existing ones. The tennew drugs most prescribed began being used during the first fourmonths immediately after coming out on the market. The percentageof use of new drugs as compared to all of the drugs prescribed at thehealthcare centers studied fell within the 0.3% -1.18% range. In theanalysis made by centers, the «per-patient expense» and the «consultationsper physician» are positively correlated with a greater useof new drugs, whilst the percentage of retirees showed a reverseratio.Conclusions: A high degree of variability exists in the percentageof use of pharmaceutical novelties among the primary care centers.The centers having the largest number of consultations perphysician are those tending toward more readily incorporating thesenew drugs

Subregistro de las infecciones postoperatorias en el conjunto mínimo de datos básicos (CMBD) / Underregistration of postoperative infections in the Minimun Basic Data (MBDS)

Objetivos: El Conjunto Mínimo Básico de Datos (CMBD) se ha utilizado para estimar la complejidad de los pacientes y elaborar indicadores de calidad, no obstante, se han descrito problemas de calidad y exhaustividad en el mismo. El objetivo de este estudio es evaluar la calidad del registro de infecciones postoperatorias en el CMBD en un hospital de tercer nivel y analizar las variables relacionadas. Métodos: Se diseñó un estudio observacional retrospectivo, en el que se comparó la información disponible sobre infección postoperatoria en el CMBD con la de la base de datos del sistema de vigilancia activa del Servicio de Medicina Preventiva, que se consideró sistema de referencia (gold standard). Se incluyeron todos los episodios de hospitalización en los que el Servicio de Medicina Preventiva encontró una infección postoperatoria. Las infecciones se clasificaron en Infección Superficial de la Herida (ISH), Infección Profunda de la Herida (IPH) e Infección de Órgano/Espacio (IOE). Los criterios diagnósticos utilizados fueron los establecdos por los Centers for Disease Control. Por medio de un modelo de regresión logística, se analizó la asociación entre variables relacionadas con el paciente y el episodio de ingreso, y el registro o no de la infección postoperatoria en el CMBD. Resultados: El sistema de vigilancia registró 300 casos de infección postoperatoria, con una incidencia acumulada anual de 2,8 por ciento. De ellas 219 correspondían a IHS, 27 a IPH y 54 a IOE. En 172 casos (57,3 por ciento) no aparece el código de "infección postoperatoria" en el CMBD. Esta proporción es el 57,5 por ciento en la ISH, el 44,4 por ciento en la IPH y el 63 por ciento en las IOE. En el modelo de regresión logística incluimos el servicio que da el alta y el tipo de infección. Conclusiones: Existe un importante subrregistro en el CMBD de las complicaciones infecciosas asociadas a la cirugía. No encontramos ninguna variable claramente relacionada con el registro de la infección postoperatoria. El diseño de estrategias de intervención nos llevarían a mejorar la calidad de los informes médicos y el correcto registro de las complicaciones infecciosas. Estas estrategias deberían estar dirigidas a los servicios con mayor margen de mejora en el índice de case-mix y peor calidad de información clínica recogida en el CMBD (AU)

Injerto de periostio en las timpanoplastias / Graft of the periosteum in tympanoplasty

Presentamos los resultados obtenidos en 310 pacientes, empleando como injerto el periostio mastoideo en 70 miringoplastias y 240 timpanoplastias, tipo II, III ó IV, realizadas en el Hospital "Ildemaro Salas" del Instituto Venezolano de los Seguros Sociales, en Caracas, durante 10 años, (1975 a 1985), ambas fechas inclusive. De acuerdo a nuestra experiencia, se considera que el injerto de periostio mastoideo es una alternativa para el empleo en las timpanoplastias, dando origen a un neotímpano suficientemente elástico, que evoluciona en un período de meses y medio hacia la formación de una membrana timpánica, indiferenciable de una membrana normal a la simple otoscopia y que responde en forma adecuada a la onda sonora, siendo por lo mismo útil para el cierre de la perforación y la reconstitución de la membrana timpánica en las timpanoplastias