Review on the management of cardiovascular risk factors in the elderly.

Cardiovascular risk factors (CVRF) are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline, which limits the quality of life in this population. The objective of this work is to offer a review of the current evidence in the management of CVRF in the elderly population. The search strategy was executed in PubMed, Clinicalstrials.org and Embase, to search for clinical trials, observational cohort or cross-sectional studies, reviews, and clinical practice guidelines focused or including elderly population. The results provided were refined after reading the title and abstract, as well as elimination of duplicates, and were finally identified and assessed following the GRADE methodology. A total of 136 studies were obtained for all predefined risk factors, such as sedentary lifestyle, smoking, obesity and metabolic syndrome, hypertension, diabetes mellitus, dyslipidemia and alcohol. We described the results of the studies identified and assessed according to their methodological quality in different recommendation sections: diagnostic and prevention, intervention, or treatment in the elderly population. As the main limitation to the results of this review, there is the lack of quality studies whose target population is elderly patients. This issue limits the recommendations that can be made in this population. Due to this reason, comprehensive geriatric assessment seems the best tool currently available to implement the most appropriate treatment plans based on the baseline situation and comorbidity of each elderly patient.

Compliance with COVID-19 Prevention Measures in the Spanish Population during the New Normal: Will the Need for Greater Community Involvement Be One of the Lessons Learned?

Throughout the pandemic, national and international health authorities have called on the population to collaborate and contribute with their behavior to control the problem. The aim of this study is to analyze the implementation of the protective measures against COVID-19 and to determine the factors involved in their compliance. To respond to the objectives, a cross-sectional study was performed involving a total of 5560 individuals. An ad hoc online questionnaire was created and shared through social networks, scientific societies, and various health institutions. The probability of high or total compliance with the protective measures was higher in women (OR = 1.401) and as age increases, with an OR = 2.524 in the interval between 31 and 64 years old and an OR = 2.896 in the oldest interval (65 and over). This study shows the characteristics of the population that considers it more likely to be infected by SARS-CoV-2, thus adopting greater adherence to prevention measures. Knowing which factors are associated with adherence to protective measures is essential for establishing effective pandemic control measures. Our findings may be useful for designing future awareness campaigns adapted to different socio-demographic characteristics in settings affected by COVID-19.

Fear and Attitude towards SARS-CoV-2 (COVID-19) Infection in Spanish Population during the Period of Confinement.

In January 2020, the WHO classified SARS-CoV-2 infection as a public health emergency and it was declared a pandemic on 11 March 2020. The media warned about the danger of infection, fuelling the population's fear of the new situation and increasing the perception of risk. This fear can cause behaviour that will determine the course of the pandemic and, therefore, the purpose of this study was to analyse the fear of infection from COVID-19 among the Spanish population during the state of emergency. A cross-sectional, descriptive observational study was conducted with 16,372 participants. Data on sociodemographic factors, health factors, risk perception and fear were collected through an online survey. Level of fear is associated with older age, a lower level of education, having a person infected with SARS-CoV-2 in the immediate surroundings and living with and belonging to the most socioeconomically vulnerable group of people. Risk perception is associated with increased preventive behaviour. This paper provides relevant information for the public health sector since it contributes first-hand knowledge of population data that is highly useful in terms of prevention. Understanding the experiences of people in this pandemic helps to create more effective future intervention strategies in terms of planning and management for crisis situations.

Fármacos citostáticos y riesgo de genotoxicidad en personal sanitario. Revisión bibliográfica / Cystostatic drugs and risk of genotoxicity in health workers. A literature review

Objetivo: Analizar el riesgo genotóxico de los fármacos citostáticos en personal sanitario tras su exposición ocupacional. Método: Revisión narrativa mediante búsqueda bibliográfica en bases de datos Pubmed, Lilacs, The Cochrane Library y Scopus, con lenguaje libre y controlado (términos MeSH) utilizando los operadores booleanos AND y OR. La búsqueda se limitó a artículos publicados entre 2005-2016. Resultados. Se analizaron 11 artículos seleccionados para esta revisión bibliográfica en función de su relevancia, de los cuales 9 mostraban daño en el material genético (ADN) del personal sanitario expuesto a citostáticos. Además, cabe señalar que las actuales prácticas de seguridad no eliminan por completo las posibilidades de exposición, por lo que es necesaria la creación de nuevos estudios clínicos. Conclusiones: La manipulación de citostáticos puede causar un riesgo genotóxico al personal sanitario que se encuentra expuesto a estas sustancias. Dicho riesgo puede producir modificaciones en el ADN del organismo de estos trabajadores. No existen datos suficientes para demostrar la relación causa-efecto entre el riesgo genotóxico y el efecto adverso en el individuo. La educación para la salud será el principal medio para la concienciación y prevención del personal en riesgo.(AU)

Objective. To analyse the genotoxic risk of cytostatic drugs in health professionals after occupational exposure. Method: The literature was searched using the databases PubMed, Lilacs, The Cochrane Library and Scopus with free and controlled language (MeSH terms) using Boolean operators AND and OR. The research was limited to articles published between 2005-2016. Results: 11 articles were selected depending on their relevancy to this review's aim. Nine of the 11 articles proved the existence of damage to genetic material (DNA) of health workers, who were exposed to cytostatics. Furthermore, current security practices do not fully eliminate the chance of exposure. Therefore, new clinical trials are required. Conclusions: Handling cytostatic drugs can cause a genotoxic risk to health workers who are exposed to these substances. This exposure may cause damage to the workers’ DNA. There are not enough data to prove a cause-effect relationship between the genotoxic risk and adverse reactions in individuals. Health education will be the main way to raise awareness of and prevent this problem.(AU)

Cytostatic drugs and risk of genotoxicity in health workers. A literature review.

OBJECTIVE: To analyse the genotoxic risk of cytostatic drugs in health professionals after occupational exposure. METHOD: Literature was searched for the databases PubMed, Lilacs, The Cochrane Library and Scopus with free and controlled language (MeSH terms) using boolean operators AND and OR. The research was limited to articles published between 2005-2016. RESULTS: 11 articles were selected depending on their relevancy to this review's aim. Nine of the 11 articles proved the existence of damage to genetic material (DNA) of health workers, who were exposed to cytostatics. Furthermore, current security practices do not eliminate the chance of exposure completely. Therefore, the creation of new clinical trials is required. CONCLUSIONS: Handling cytostatic drugs can cause a genotoxic risk to health workers who are exposed to these substances. This exposure may cause damage on the workers' DNA. There are not enough data to prove a cause-effect relationship between the genotoxic risk and adverse reactions on individuals. Health education will be the main way to raise the awareness and prevention this problem.

Perception of musculoskeletal pain in the state of confinement: associated factors.

OBJECTIVE: to describe the perception of musculoskeletal pain in the population and how the state of confinement (adopted as a measure to control contagion by COVID-19) has interfered with it, as well as identifying the sociodemographic, occupational, physical, and psychosocial factors involved. METHOD: an observational, cross-sectional and analytical study, with simple random probabilistic sampling, aimed at residents in Spain over 18 years old during the confinement period. An ad hoc survey was conducted, consisting in 59 items. RESULTS: a total of 3,247 surveys were answered. Persistent musculoskeletal pain or significant episodes thereof increased 22.2% during confinement. The main location was the spine (49.5%). The related factors were decreased physical activity, increased seated position, and use of electronic devices. The psychological impact of confinement was also related to the perception of musculoskeletal pain. CONCLUSION: the state of confinement causes an increase in the perception of musculoskeletal pain. The identification of a particularly sensitive population profile, as well as that of the related factors, allows establishing multidisciplinary approaches in health promotion.

Effects of Manual Therapy on the Diaphragm in the Musculoskeletal System: A Systematic Review.

OBJECTIVES: To analyze the effects at the musculoskeletal level of manual treatment of the diaphragm muscle in adults. DATA SOURCES: Systematic review using 4 databases: PubMed, Science Direct, Web of Science, and Scopus. STUDY SELECTION AND DATA EXTRACTION: Two independent reviewers applied the selection criteria and assessed the quality of the studies using the Physiotherapy Evidence Database scale for experimental studies. A third reviewer intervened in cases where a consensus had not been reached. A total of 9 studies were included in the review. DATA SYNTHESIS: Manual therapy directed to the diaphragm has been shown to be effective in terms of the immediate increase in diaphragmatic mobility and thoracoabdominal expansion. The immediate improvement in the posterior muscle chain flexibility test is another of the most frequently found findings in the evaluated studies. Limited studies show improvements at the lumbar and cervical level in the range of motion and in pain. CONCLUSION: Manual diaphragm therapy has shown an immediate significant effect on parameters related to costal, spinal, and posterior muscle chain mobility. Further studies are needed, not only to demonstrate the effectiveness of manual diaphragm therapy in the long-term and in symptomatic populations, but also to investigate the specific neurophysiological mechanisms involved in this type of therapy.

Effects of diaphragm muscle treatment in shoulder pain and mobility in subjects with rotator cuff injuries: A dataset derived from a pilot clinical trial.

The rotator cuff inflammatory or degenerative pathology is the main cause of shoulder pain. The shoulder and diaphragm muscle have a clear relation through innervation and the connection through myofascial tissue. A prospective, randomized, controlled, single-blind (assessor) pilot clinical trial was performed with a sample size of 27 subjects with rotator cuff injuries and with clinical diagnosis of myofascial pain syndrome at shoulder. The sample were divided into 3 groups of treatment (9 subjects per group):1.A direct treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (control / rotator cuff group).2.Diaphragm manual therapy techniques (diaphragm group).3.Active diaphragm mobilization by breathing exercises (breathing exercises group).The pain and range of shoulder motion were assessed before and after treatment in all the participants by inclinometry, NRS of pain in shoulder movements and pressure algometry. Methodology and full data analyzing the effect of the three interventions are presented in this article. These data could give a basis for further experiments on revealing the underlying mechanism of action of the visceral manual therapy in reducing the symptoms of shoulder pain.

Perception of musculoskeletal pain in the state of confinement: associated factors / Percepção da dor musculoesquelética em estado de confinamento: fatores associados / Percepción de dolor musculoesquelético en estado de confinamiento: factores asociados

Objective: to describe the perception of musculoskeletal pain in the population and how the state of confinement (adopted as a measure to control contagion by COVID-19) has interfered with it, as well as identifying the sociodemographic, occupational, physical, and psychosocial factors involved. Method: an observational, cross-sectional and analytical study, with simple random probabilistic sampling, aimed at residents in Spain over 18 years old during the confinement period. An ad hoc survey was conducted, consisting in 59 items. Results: a total of 3,247 surveys were answered. Persistent musculoskeletal pain or significant episodes thereof increased 22.2% during confinement. The main location was the spine (49.5%). The related factors were decreased physical activity, increased seated position, and use of electronic devices. The psychological impact of confinement was also related to the perception of musculoskeletal pain. Conclusion: the state of confinement causes an increase in the perception of musculoskeletal pain. The identification of a particularly sensitive population profile, as well as that of the related factors, allows establishing multidisciplinary approaches in health promotion.

Objetivo: descrever a percepção da dor musculoesquelética na população e como o estado de confinamento (adotado como medida de controle do contágio pela COVID-19) tem interferido na mesma, bem como identificar os fatores sociodemográficos, ocupacionais, físicos e psicossociais envolvidos. Método: estudo observacional, transversal e analítico, com amostragem probabilística aleatória simples, realizado com residentes na Espanha, maiores de 18 anos, durante o período de confinamento, para tanto, foi realizada uma enquete ad-hoc com 59 itens. Resultados: foram recebidas 3.247 respostas. Dor musculoesquelética persistente ou episódios significativos da mesma aumentaram em 22,2% durante o confinamento. A localização principal foi a coluna vertebral (49,5%). Os fatores relacionados foram a diminuição da atividade física, o aumento da posição sentada e o uso de dispositivos eletrônicos. O impacto psicológico do confinamento também esteve relacionado à percepção de dor musculoesquelética. Conclusão: o estado de confinamento acarreta aumento na percepção da dor musculoesquelética. A identificação de um perfil populacional particularmente sensível, bem como dos fatores relacionados, permite estabelecer abordagens multidisciplinares na promoção da saúde.

Objetivo: describir la percepción de dolor musculoesquelético en la población y cómo el estado de confinamiento (adoptado como medida de control de contagio por COVID-19) ha interferido en la misma, así como identificar los factores sociodemográficos, laborales, físicos y psicosociales implicados. Método: estudio observacional, transversal y analítico, con muestreo probabilístico aleatorio simple, dirigido a residentes en España, mayores de 18 años durante el periodo de confinamiento. Se realizó una encuesta ad-hoc compuesta por 59 ítems. Resultados: se cumplimentaron 3247 encuestas. El dolor musculoesquelético persistente o los episodios significativos del mismo se incrementaron un 22,2% durante el confinamiento. La principal localización fue el raquis (49,5%). Los factores relacionados fueron la disminución de la actividad física, el aumento de la posición sentada y del uso de dispositivos electrónicos. El impacto psicológico del confinamiento también se relacionó con la percepción de dolor musculoesquelético. Conclusión: el estado de confinamiento provoca un incremento en la percepción de dolor musculoesquelético. La identificación de un perfil poblacional especialmente sensible, así como la identificación de los factores relacionados, permite establecer abordajes multidisciplinares en la promoción de la salud.

Risk Perception of COVID-19 Community Transmission among the Spanish Population.

On 11 March 2020 the SARS-CoV-2 virus was officially declared a pandemic and measures were set up in various countries to avoid its spread among the population. This paper aims to analyse the perception of risk of COVID-19 infection in the Spanish population. A cross-sectional, descriptive observational study was conducted with a total of 16,372 Spanish participants. An online survey was used to gather data for 5 consecutive days over the compulsory lockdown period which was established after the state of emergency was declared. There is an association between socio-demographic variables and risk perception, and a very strong relationship between this perception and contact and direct experience with the virus in a family, social or professional setting. We also found that compared to working from home, working outside the home increased the perception of risk of infection and the perception of worsening health. Understanding the public perception of the risk of COVID-19 infection is fundamental for establishing effective prevention measures.

Validación del termómetro como factor determinante de la eficacia en la toma de temperatura por infección de COVID-19 / Validation of the thermometer as a determining factor in the effectiveness of temperature measuring in covid-19 infection

FUNDAMENTOS: La pandemia por COVID-19 ha alcanzado más de cinco millones de contagios y trescientos mil fallecidos en el mundo. Todos ellos precisan la evaluación de factores pronósticos; además de la edad avanzada, las comorbilidades o la respuesta inflamatoria, es también evidente la necesidad de evaluar la temperatura corporal para determinar el contagio, la exposición, especialmente en personas con diferentes factores de riesgo, y distintos patrones evolutivos para conocer su influencia sobre los desenlaces clínicos. MÉTODOS: Se realizó un estudio transversal de tomas de temperatura a 42 sujetos voluntarios, para valorar la fiabilidad en términos de concordancia entre dos termómetros utilizados en las tomas de temperatura corporal; se compararon las mediciones de 2 termómetros en las zonas frontal y oído en 2 salas (mayor y menor iluminación). Se compararon los intervalos de confianza y se calculó el coeficiente de Correlación Intraclase (CCI) para obtener las diferencias estadísticas, proporcionando unos límites de concordancia a partir del cálculo del intervalo de confianza para la diferencia de dos mediciones. RESULTADOS: Con un intervalo de confianza del 95 %, una p < 0,5 y en las condiciones medidas, y sobre la muestra de sujetos, observamos que la correlación de las mediciones no tiene diferencia estadística significativa, pero sí en los diferentes ambientes con mayor iluminación. CONCLUSIONES: La media de temperatura corporal (frontal) medida con el termómetro láser es mayor que la temperatura (frontal) medida con el termómetro Testo. Existe diferencia significativa en las mediciones realizadas en las 2 salas, siendo mayores en la sala con menor iluminación. Hay correlación en las mediciones de temperatura del mismo instrumento en la zona frontal y en oído. Los termómetros láser son más efectivos para detectar las variaciones en la temperatura corporal, y más asertivos para identificar uno de los síntomas más asociados a la infección por SARS-CoV-2

BACKGROUND: The COVID-19 pandemic has reached more than five million infections and three hundred thousand deaths worldwide, all of which require the assessment of prognostic factors; in addition to advanced age, comorbidities or the inflammatory response, is also evident the need to assess body temperature to determine contagion, exposure, especially in people with different risk factors, and different evolutionary patterns to know its influence on clinical outcomes. METHODS: A cross-sectional study of temperature measurements was performed on 42 volunteer subjects, to assess the reliability in terms of agreement between two thermometers used in body temperature measurements; the measurements of 2 thermometers in the frontal and ear areas were compared in 2 rooms (higher and lower lighting). Confidence intervals were compared and the Intraclass Correlation Coefficient (ICC) was calculated to obtain the statistical differences, providing limits of agreement from the calculation of the confidence interval for the difference of two measurements. RESULTS: With a 95 % confidence interval, a p <0.5 and under the measured conditions, and on our sample of subjects, we observe that the correlation of the measurements does not have significant statistical difference, but indeed in different environments with greater lighting. CONCLUSIONS: The average body temperature (front) measured with the laser thermometer is greater than the temperature (front) measured with the Testo thermometer. There is a significant difference in the measurements made in the 2 rooms, being greater in the room with less lighting. There is correlation in the temperature measurements of the same instrument in the frontal zone and in the ear. Laser thermometers are more effective in detecting variations in body temperature, and more assertive in identifying one of the symptoms most associated with SARS-CoV-2 infection

¿Preparados para el nuevo coronavirus? / Are We Ready for the New Coronavirus?

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Estigma en personas con enfermedad mental desde el punto de vista de estudiantes de Grado de Enfermería y Fisioterapia / Stigma in persons with mental conditions from the point of view of Nursing and Physical Therapy undergraduate students

Objetivo: describir la percepción que tienen los estudiantes de Ciencias de la Salud acerca de las personas con problemas de salud mental e identificar los factores que se relacionan con dichas atribuciones. Método: estudio descriptivo transversal llevado a cabo en 2018. La muestra estaba formada por estudiantes de Enfermería y Fisioterapia del Centro Universitario de Ciencias de la Salud San Rafael-Nebrija de Madrid (España). Se recopilaron variables identi- ficativas del sujeto de estudio y se utilizó el cuestionario de Atribución AQ-27, que consta de 27 ítems y nueve factores que informan sobre responsabilidad, piedad, ira, peligrosidad, miedo, ayuda, coacción, segregación y evitación. Se realizaron análisis uni y bivariantes. Resultados: participaron 262 estudiantes de Ciencias de la Salud, 67,8% (n= 177) del Grado de Enfermería y 32,2% (n= 84) del Grado de Fisioterapia. El 77,4% (n= 202) era mujer. La edad osciló entre 18-45 años. El 9,3% tenía formación en salud mental, el 9,9% experiencia laboral en el área, el 23,3% presentó antecedentes familiares en trastornos de salud mentaly el 7% antecedentes personales. Los valores medios (desviación estándar) más altos los presentaron en los factores "ayuda" 7,66 (1,37), "coacción" 6,56 (1,62) y "piedad" 6,51 (1,36). Los más bajos en "ira" 3,41 (1,79) y "responsabilidad" 2,50 (1,35). Se encontraron diferencias estadísticamente significativas (p< 0,05) en ira y ayuda respecto al título de Grado; en segregación respecto a la formación previa en salud mental; y en peligrosidad, miedo, ayuda, segregación y evitación respecto a antecedentes personales en salud mental. Conclusiones: los estudiantes de Ciencias de la Salud destacan en las dimensiones de ayuda, piedad y coacción; y obtienen valores más bajos en ira y responsabilidad. La formación previa en salud mental influye sobre el factor segregación. La presencia de antecedentes personales en salud mental influye sobre los factores miedo, peligrosidad, ayuda, segregación y evitación

Objective: to describe the perception by Health Sciences students of persons with mental health problems, and to identify the factors associated with said attributions. Method: a descriptive cross-sectional study conducted on 2018. The sample included Nursing and Physical Therapy students from the Centro Universitario de Ciencias de la Salud San Rafael-Nebrija from Madrid (Spain). Identification variables of the study subject were collected, and the AQ-27 Attribution Questionnaire was used, which consists of 27 items and nine factors informing about Blame, Anger, Pity, Dangerousness, Fear, Help, Segregation, Coercion and Avoidance. Univariate and bivariate analyses were carried out. Results: the study included the participation of 262 Health Sciences students: 67.8% (n= 177) from Nursing and 32.2% (n= 84) from Physical Therapy; 77.4% (n= 202) were female. There was an 18-to-45-year-old age range; 9.3% had mental health training, 9.9% had working experience in the area, 23.3% presented a family background with mental health disorders, and 7% had a personal background. The highest mean values (standard deviation) were present in the following factors: "help" with 7.66 (1.37), "coercion" with 6.56 (1.62), and "pity" with 6.51 (1.36). The lowest values (p≤ 0.05) were found in "anger" with 3.41 (1.79) and "blame" with 2.50 (1.35). Statistically significant differences were found in Anger and Help in terms of the type of degree; in Segregation in terms of previous training in Mental Health; and in Dangerousness, Fear, Help, Segregation and Avoidance in terms of personal mental health background. Conclusions: Health Sciences students stood out in the Help, Pity and Coercion dimensions, and obtained lower values in Anger and Blame. Previous training in mental health had impact on the Segregation factor. The presence of personal background in mental health had impact on these factors: Fear, Dangerousness, Help, Segregation and Avoidance

Cystostatic drugs and risk of genotoxicity in health workers. A literature review. / Fármacos citostáticos y riesgo de genotoxicidad en personal sanitario. Revisión bibliográfica.

OBJECTIVE: To analyse the genotoxic risk of cytostatic drugs in health professionals after occupational exposure. METHOD: The literature was searched using the databases PubMed, Lilacs, The Cochrane Library and Scopus with free and controlled language (MeSH terms) using Boolean operators AND and OR. The research was limited to articles published between 2005-2016. RESULTS: 11 articles were selected depending on their relevancy to this review's aim. Nine of the 11 articles proved the existence of damage to genetic material (DNA) of health workers, who were exposed to cytostatics. Furthermore, current security practices do not fully eliminate the chance of exposure. Therefore, new clinical trials are required. CONCLUSIONS: Handling cytostatic drugs can cause a genotoxic risk to health workers who are exposed to these substances. This exposure may cause damage to the workers' DNA. There are not enough data to prove a cause-effect relationship between the genotoxic risk and adverse reactions in individuals. Health education will be the main way to raise awareness of and prevent this problem.