El coste de la infección en artroplastia de cadera: estudio de casos y controles emparejado / The cost of infection in hip arthroplasty: a matched case-control study

Objetivo. La infección de localización quirúrgica (ILQ) representa el 30% de todas las causas de infecciones relacionadas con la atención sanitaria (IRAS), siendo una de las complicaciones más temidas en pacientes quirúrgicos. Se estimó el exceso de costes directos de la ILQ mediante un estudio de casos y controles emparejado y anidado en una cohorte, en un hospital de agudos en España (Hospital Universitario Ramón y Cajal). Material y método. Los casos fueron pacientes que desarrollaron un primer episodio de ILQ según los criterios establecidos por el National Healthcare Safety Network de los CDC. Los controles fueron emparejados a los casos en una razón de 1:1, teniendo en cuenta la clasificación de la American Society of Anesthesiologists, la edad, el sexo, la fecha de la cirugía y el diagnóstico principal. Resultados. Este estudio encontró que la infección en reemplazo de cadera incrementó los costes directos en un 134%. Asimismo, el exceso de costes debido a la infección causada por Staphylococcus aureus resistente a la meticilina fue 69% mayor que el exceso de costes debido a las infecciones causadas por otros microorganismos. onclusiones. La ILQ después de reemplazo de cadera sigue siendo una complicación costosa desde la perspectiva del hospital. Los costes debidos a la ILQ pueden ser utilizados para priorizar intervenciones preventivas de vigilancia y control de las infecciones relacionadas con la atención sanitaria (AU)

Objective. Surgical site infection (SSI) represents 30% of all causes of health care-associated infection (HAI) and is one of the most dreaded complications in surgical patients. We estimated the excess direct costs of SSI using a matched nested case-control study in acute-term care at Ramon y Cajal University Hospital in Spain. Material and method. Cases were patients who developed a first episode of SSI according to the criteria established by the CDC's National Healthcare Safety Network. Controls were matched to cases in 1:1 ratio taking into account the American Society of Anesthesiologists score, age, sex, surgery date, and principal diagnosis. Results. This study found that infection in hip replacement increased direct costs by 134%. Likewise, the excess cost due to the infections caused by methicillin resistant Staphylococcus aureus was 69% higher than the excess cost attributable to infections caused by other microorganisms. Conclusions. SSI after hip replacement continues to be a costly complication from the hospital perspective. Costs due to SSI can be used to prioritise preventive interventions to monitor and control HAI (AU)

The cost of infection in hip arthroplasty: a matched case-control study. / El coste de la infección en artroplastia de cadera: estudio de casos y controles emparejado.

OBJECTIVE: Surgical site infection (SSI) represents 30% of all causes of health care-associated infection (HAI) and is one of the most dreaded complications in surgical patients. We estimated the excess direct costs of SSI using a matched nested case-control study in acute-term care at Ramon y Cajal University Hospital in Spain. MATERIAL AND METHOD: Cases were patients who developed a first episode of SSI according to the criteria established by the CDC's National Healthcare Safety Network. Controls were matched to cases in 1:1 ratio taking into account the American Society of Anesthesiologists score, age, sex, surgery date, and principal diagnosis. RESULTS: This study found that infection in hip replacement increased direct costs by 134%. Likewise, the excess cost due to the infections caused by methicillin resistant Staphylococcus aureus was 69% higher than the excess cost attributable to infections caused by other microorganisms. CONCLUSIONS: SSI after hip replacement continues to be a costly complication from the hospital perspective. Costs due to SSI can be used to prioritise preventive interventions to monitor and control HAI.

Epidemiología del síndrome de burnout / Burnout syndrome epidemiology

El síndrome de burnout constituye un proceso de alta prevalencia e importantes consecuencias entre los profesionales sanitarios y especialmente en enfermería. Por ello nos hemos propuesto estudiar las tres dimensiones del síndrome (cansancio emocional, despersonalización y falta de realización) y la función que ciertos factores personales, laborales e institucionales tienen en el desarrollo del proceso. Se realizó un estudio transversal tras un muestreo aleatorio entre todo el personal adscrito al área de enfermería de un hospital de Madrid. Se aplicaron dos tipos de instrumentos de recogida de información: un cuestionario que recopilaba variables sociodemográficas, laborales e institucionales y el Maslach Burnout Inventory (MBI) en su versión validada en español, que estudiaba las tres dimensiones del síndrome de burnout. Se realizó un análisis de regresión logística múltiple, tomando como variables dependientes las tres escalas del síndrome y ajustando por todas las demás variables. Se mostraron como factores de riesgo claro las opiniones desfavorables de los profesionales de las variables institucionales, siendo especialmente importantes para la escala de cansancio emocional(AU)

The burnout syndrome constitutes a process which bears high prevalence and important consequences among sanitary professionals, particularly among nurses. Therefore, the authors have proposed to study the three dimensions of this syndrome, namely emotional tiredness, depersonalization and lack of a sense of achievement plus the function certain personal, labor, and institutional factors have in development of this process. The authors carried out a transversal study based on a random sample from among all the nursing staff at a Madrid hospital. Two methods to gather information were employed: one questionnaire gathered socio-demographic data, labor and institutional variables while the Maslach Burnout Inventory (MBI), in its verified Spanish version, studied the three burnout syndrome dimensions. The authors made a multiple logistical regression analysis, using as dependent variables the three syndrome scales and adjusting parameters for all the other variables. Clear risk factors were shown; these included unfavorable opinions professionals hold regarding institutional variables; the scale for emotional tiredness warrants special note(AU)

Epidemiología de las malformaciones congénitas y de sus factores de riesgo / Epidemiology of congenital malformations and their risk factors

Las malformaciones congénitas son importantestanto por su prevalencia como por la mortalidad infantily la minusvalía que, gran parte de ellas, ocasionan.Si bien al estudiar la evolución temporal de la mortalidady prevalencia, en nuestro país, ha descendido,hay que considerar que desde que se aprobó la Ley9/1985 la Interrupción Voluntaria del Embarazo es legal.Al estudiar sus factores de riesgo, se considerahabitualmente 4 grupos etiológicos: de causa desconocida,genéticos, ambientales y multifactoriales (enlos que hay interacción entre los factores genéticos yambientales). En nuestro país, las embriofetopatíasmás frecuentes son las producidas por estas dos últimascausas, la alcohólica y las derivadas de la diabetescrónica y la terapia antiepiléptica, hecho a considerarpor la posibilidad de actuación frente a ellas. Enesta revisión, se habla también de los diferentes factoresde riesgo relacionados con estos procesos; finalmente,se trata sobre la prevención primaria de losdefectos del cierre del tubo neural mediante el consumo,previo a la concepción, de ácido fólico, y la controversiagenerada al respecto

Congenital malformations are important not onlybecause of their prevalence, but for the infantilemortality and the disability that most of them cause.The study of the temporary evolution of mortalityand prevalence in Spain shows a decrease of thesefacts; however, we should consider the possibleinfluence that the prevailing law 9/1985 about thevoluntary interruption of the pregnancy may havecaused on these figures .When studying the riskfactors of congenital malformations, four etiologicalgroups are usually taken into consideration: unknowncause, genetic cause, environmental causeand multifactorial cause (in which there is an interactionbetween genetic and environmental factors).On the other hand, the most frequent embryopathiesin Spain are caused by the alcohol, thechronic diabetes and anticonvulsant drugs. Thesefactors facilitate a preventive action against thesediseases. This review talks about the different riskfactors related to these processes. Finally, the textdeals with the primary prevention of the neural tubedefects by the folic acid supplementation, previousto the conception, and the controversy generatedby this fact

[Epidemiological characteristics of breast cancer development in pre and postmenopausal women]. / Características epidemiológicas relacionadas con el cáncer de mama en mujeres pre y posmenopáusicas.

BACKGROUND: To study the relation between breast cancer and different risk factors, personal, familial and demographic factors. An statistic and epidemiologic study was also carried on a whole population of women and then classified on pre and postmenopausal women. PATIENTS AND METHODS: A matched case-control study was performed based on age, urban area and hormonal activity. Total population was composed by 274 cases and same number of controls. Studied variables were obtained by a questionnaire asking for study level, reproductive and personal history, familial considerations and lifestyles. A multiples logistic regression model was made. RESULTS: Over total population, late menarcheal age, late first pregnancy, and familial history of breast cancer were shown as independent risk factors, but a low study level, and oral contraception were shown as protective factors. This risk model was confirmed on postmenopausal women but no over premenopausal women, so in this group, main risk factors were familial breast cancer history and a medical history of benign breast disease. Moreover, the low study level was also a protective factor. CONCLUSIONS: Familial history of breast cancer in mothers or sisters was the main risk factor for breast cancer, mainly in premenopausal women, and low study level showed as protective factor.

[The evaluation of the mutagenic activity of public drinking water by the Ames test]. / Evaluación de la actividad mutagénica de aguas de consumo público por medio del test de Ames.

BACKGROUND: The sources of potential mutagens in our environment are many, but the most important of these is water for public consumption. This is a result of the chlorinating process which is the main reason for the appearance of these mutagens. With this in mind, the aim of our study was to check a possible mutagenic activity, using the Ames test, in organic concentrates taken from water for public consumption in Madrid. METHODS: Several bacterial strains were used, namely Salmonella histidine dependent TA1535, TA1538, TA98 and TA100, taken originally from Salmonella typhimurium LT2. Each test was performed twice, with or without the introduction of the mammalian-microsome activation (S9 mix), as per the indications in Ames. The plate incorporation assay was used to test the mutagenicity. All samples of the water in question were processed and treated so as to create concentrates of organic chlorinated compounds. RESULTS: The highest levels of mutagenicity appeared in the TA1535 strain and in the tests where the microsome fraction was not used (IM = 1.94). CONCLUSIONS: With regard to mutagenic evaluation in organic concentrates taken from water for public consumption, no positive activity was found in any of the tester strains.