Differences between GH and PRL co-secreting and GH-secreting pituitary adenomas. A series of 604 cases.

PURPOSE: To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas (GH&PRL-PAs). METHODS: Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs who did not meet the previously mentioned criteria (n=474). RESULTS: GH&PRL-PAs represented 21.5% (n=130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [IQR 1.73-3.29] vs. 2.7 [IQR 1.91-3.67], P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients. CONCLUSIONS: GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.

Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers.

OBJECTIVE: This study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. METHOD: The research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. RESULTS: Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. CONCLUSIONS: This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers' fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.

Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers / Afrontar lo desconocido: percepciones, temores y preocupaciones del personal hospitalario ante la infección por SARS-CoV-2

Objective: This study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. Method: The research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. Results: Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. Conclusions: This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers’ fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.(AU)

Objetivo: Este estudio explora los temores y las preocupaciones respecto al riesgo de infección y transmisión del SARS-CoV-2 a familiares, compañeros de trabajo y pacientes en relación con las intervenciones preventivas no farmacológicas entre el personal hospitalario (incluido personal de medicina, personal de enfermería y auxiliares, y personal de limpieza, mantenimiento y seguridad) de una institución sanitaria de Barcelona (España), durante la primera y segunda oleadas de la pandemia por SARS-CoV-2. Método: La investigación utilizó un enfoque cualitativo exploratorio. Se realizaron seis grupos focales y diez entrevistas individuales en línea, que se grabaron en audio, se transcribieron literalmente y se analizaron mediante análisis temático y codificación mixta. Resultados: Participaron en el estudio 40 profesionales. En todos los grupos surgieron cuatro temas comunes: retos relacionados con la falta de preparación ante una pandemia, preocupaciones sobre el equipo de protección personal, directrices poco claras para el rastreo de casos y contactos, y dificultades relacionadas con la comunicación. Conclusiones: Este estudio hace hincapié en las recomendaciones clave para mejorar las intervenciones preventivas no farmacológicas con el fin de reducir los temores y las preocupaciones de los trabajadores sobre el riesgo de infección y de contagio a otras personas, incluidas las familias. Por encima de todo, estas deben incluir garantizar la disponibilidad y el uso correcto de equipos de protección individual adecuados, mejorar las directrices sobre el rastreo de casos y contactos, y establecer canales de comunicación eficaces para todos los trabajadores de la organización. Estas recomendaciones deben reforzarse en el personal de mantenimiento y seguridad, así como en el personal de enfermería y auxiliares del turno de noche, para reducir también las desigualdades sanitarias.(AU)

Recommendations for the diagnosis and radiological follow-up of pituitary neuroendocrine tumours.

Pituitary neuroendocrine tumours (PitNETs) constitute a heterogeneous group of tumours with a gradually increasing incidence, partly accounted for by more sensitive imaging techniques and more extensive experience in neuroradiology in this regard. Although most PitNETs are indolent, some exhibit aggressive behaviour, and recurrence may be seen after surgical removal. The changes introduced in the WHO classification in 2017 and terminological debates in relation to neuroendocrine tumours warrant an update of the guidelines for the diagnosis, preoperative and postoperative management, and follow-up of response to treatment of PitNETs. This multidisciplinary document, an initiative of the Neuroendocrinology area of the Sociedad Española de Endocrinología y Nutrición [Spanish Society of Endocrinology and Nutrition] (SEEN), focuses on neuroimaging studies for the diagnosis, prognosis and follow-up of PitNETs. The basic requirements and elements that should be covered by magnetic resonance imaging are described, and a minimum radiology report to aid clinicians in treatment decision-making is proposed. This work supplements the consensus between the Neuroendocrinology area of the SEEN and the Sociedad Española de Anatomía Patológica [Spanish Society of Pathology] (SEAP) for the pathological study of PitNETs.

[Proposal for a summary index of the non-pharmacological preventive measures adopted against SARS-CoV-2 in companies, the case of Parc de Salut Mar (Barcelona).] / Propuesta de un índice que resume las medidas preventivas no farmacológicas adoptadas frente al SARS-CoV-2 en las empresas, el caso del Parc de Salut Mar (Barcelona).

INTRODUCTION: Construct a numerical index of non-pharmacological preventive measures against Sars-CoV-2 based on the experience of Parc de Salut Mar (PSMar), a healthcare institution in Barcelona. METHOD: The construction of the index was carried out in three phases. The identification and selection of the variables to be included based on semi-structured interviews with key informants and documental revision. The definition of the dimensions (consisting of one or more variables) and, finally, the operationalisation of the index on the basis of these dimensions. The index was estimated in the PSMar, and in its two main centres, the Hospital del Mar and the Hospital de la Esperanza. RESULTS: Twenty-one variables were identified and categorised into six dimensions: personal protective equipment, individual organisational measures, collective organisational measures, epidemiological surveillance measures, training activities and protocol development. During the first wave, the Hospital del Mar index remained above the value obtained at the Hospital de la Esperanza, while in the second wave both indexes showed similar values until week 36, when the Hospital del Mar index began to show higher values. These oscillations were mainly due to the dimensions of personal protective equipment and training activities. CONCLUSIONS: The proposed index shows the difficulties in implementing the various non-pharmacological preventive measures in the first weeks of the pandemic. This tool can be useful for evaluating the activities carried out by the Occupational Risk Prevention Services in the face of the pandemic, with the appropriate adaptations to the reality of each individual company.

Introducción: Construir un índice numérico con las medidas preventivas no farmacológicas frente a Sars-CoV-2 a partir de la experiencia del Parc de Salut Mar (PSMar), una institución sanitaria en Barcelona. Método: La construcción del índice se ha realizado en tres fases. La identificación y selección de las variables incluidas a partir de entrevistas semiestructuradas a informantes clave y la revisión documental. La definición de las dimensiones (con una o más variables) y la operacionalización del índice (a partir de las dimensiones). Se ha estimado el índice en el PSMar, y en sus dos principales centros, el Hospital del Mar y el Hospital de la Esperanza. Resultados: Se identificaron 21 variables, clasificadas en 6 dimensiones: equipos de protección individual, medidas organizativas individuales, medidas organizativas colectivas, medidas de vigilancia epidemiológica, actividades formativas, y elaboración de protocolos. Durante la primera ola, el índice en el Hospital del Mar se mantuvo por encima del valor obtenido en el Hospital de la Esperanza; en la segunda ola ambos índices presentaron valores similares hasta la semana 36, cuando el hospital del Mar comenzó a presentar valores superiores. Estas oscilaciones se debieron principalmente a los equipos de protección individual y actividades formativas. Conclusiones: El índice propuesto muestra las dificultades para aplicar las medidas preventivas no farmacológicas en las primeras semanas de la pandemia. Esta herramienta puede ser útil para evaluar las actividades desarrolladas frente a la pandemia por parte de los Servicios de Prevención de Riesgos Laborales, con las oportunas adaptaciones a la realidad de cada empresa.

Non-Pharmacological Preventive Measures Had an Impact on COVID-19 in Healthcare Workers before the Vaccination Effect: A Cohort Study.

Healthcare workers have been and still are at the forefront of COVID-19 patient care. Their infection had direct implications and caused important challenges for healthcare performance. The aim of this study is to assess the impact of non-pharmacological preventive measures against COVID-19 among healthcare workers. This study is based on a dynamic cohort of healthcare workers (n = 5543) who had been hired by a Spanish hospital for at least one week during 2020. Negative binomial regression models were used to estimate the incidence rate and the rate ratio (RR) between the two waves (defined from 15 March to 21 June and from 22 June to 31 December), considering natural immunity during the first wave and contextual variables. All models were stratified by socio-occupational variables. The average COVID-19 incidence rate per 1000 worker-days showed a significant reduction between the two waves, dropping from 0.82 (CI95%: 0.73-0.91) to 0.39 (0.35-0.44). The adjusted RR was 0.54 (0.48-0.87) when natural immunity was acquired during the first wave, and contextual variables were considered. The significant reduction of the COVID-19 incidence rate could be explained mainly by improvement in the non-pharmacological preventive interventions. It is needed to identify which measures were more effective. Young workers and those with a replacement contract were identified as vulnerable groups that need greater preventive efforts. Future preparedness plans would benefit from these results.

Acromegaly disease activity according to ACRODAT®, a cross-sectional study in Spain: ACROVAL study.

OBJECTIVES: To evaluate disease activity status using the Acromegaly Disease Activity Tool (ACRODAT®) in a cohort of Spanish acromegaly patients, to assess the relationship between the level of disease activity according to both ACRODAT® and the physicians' clinical evaluation, and to study the potential discrepancies in the perception of symptoms between physicians and patients. DESIGN: Multicenter, observational, descriptive and cross-sectional study. METHODS: Disease activity was assessed in adult patients with acromegaly under pharmacological treatment during at least 6 months using ACRODAT®. RESULTS: According to ACRODAT®, 48.2%, 31.8% and 20.0% of a total of 111 patients were classified as having a stable disease (S), mild disease activity (M-DA) and significant disease activity (S-DA) respectively. ACRODAT® classification of disease activity significantly correlated with physicians' opinion, with a moderate inter-rater agreement and a specificity of 92.45% (PPV = 86.21%). No correlation was found between IGF-I levels and severity of symptoms or quality of life (QoL). A decision to take clinical action was significantly more frequent in S-DA and M-DA patients than S patients but no action was taken on 5 (22.7%) and 27 (77.1%) S-DA and M-DA patients, respectively CONCLUSIONS: ACRODAT® detected disease activity in 51.8% of patients. Interestingly, although M-DA and S-DA patients were likely to be in the process of being controlled, action was not always taken on these patients. ACRODAT® is a validated and highly specific tool that may be useful to routinely monitor acromegaly and to identify patients with non-obvious disease activity by incorporating "patient-centred" parameters like symptoms and QoL to the clinical evaluation of acromegaly.

Impact and Management of COVID-19 Among Healthcare Workers in Two Acute Care Hospitals and Two Associated Long-term Care Centres in Barcelona, Spain.

OBJECTIVE: To describe the characteristics of COVID-19-related episodes in healthcare workers (HCW) of two hospitals. METHODS: Prospective study of HCW with COVID-like symptoms and/or who were close contacts of confirmed COVID-19. The percentage of positive PCRs among those with symptoms was calculated, and symptom's positive predictive value and negative predictive value. The characteristics of contacts were described, as well as the secondary clinical attack rate. RESULTS: We registered 1222 episodes of HCW with COVID-like symptoms; 340 (27.8%) had a positive PCR. In 885 episodes, a HCW was a close contact of a confirmed case. In 45.5% of these, the HCW had contact with another HCW. The secondary clinical attack rate of contacts of HCW was 14.5%. CONCLUSION: We found a high prevalence of disease and transmission between HCW during the first wave of the SARS-CoV-2 pandemic.

Correction: Do birthrates contribute to sickness absence differences in women? A cohort study in Catalonia, Spain, 2012-2014.

[This corrects the article DOI: 10.1371/journal.pone.0237794.].

Do birthrates contribute to sickness absence differences in women? A cohort study in Catalonia, Spain, 2012-2014.

AIMS: This study explores the differences in sickness absence trends in women according to reproductive age group and medical diagnoses. METHODS: Data were obtained from two administrative registries: the Continuous Working Life Sample and the Catalonian Institute of Medical Evaluations from 2012 to 2014, containing 47,879 female employees. Incidence rates and incidence risk ratios derived from Poisson and negative binomial models were calculated to compare sickness absence trends among reproductive age groups based on Catalonian birthrates: early-reproductive (25-34 years old), middle-reproductive (35-44) and late-reproductive (45-54), according to diagnostic groups, selected diseases, type of contract, occupational category, and country of origin. RESULTS: Younger women show a higher incidence of overall sickness absence compared to late-reproductive-aged women. Incidence risk ratios of sickness absence decreased significantly from early-reproductive to late-reproductive age for low back pain, hemorrhage in early pregnancy, nausea and vomiting, and abdominal and pelvic pain. DISCUSSION: The higher incidence of sickness absence due to pregnancy-related health conditions in early-reproductive women compared to other reproductive age groups, may explain the sickness absence differences by age in women. Proper management of sickness absence related to pregnancy should be a goal to reduce the sickness absence gap between younger and older women.

Prestación por riesgo durante el embarazo e incapacidad temporal en una cohorte de trabajadoras del Parc de Salut Mar (Barcelona, España) / Occupational risk during pregnancy and sick leave in a cohort of workers from Parc de Salut Mar (Barcelona, Spain)

Objetivo: Estudiar la utilización de la prestación por riesgo durante el embarazo (PRE) y de la incapacidad temporal por contingencia común (ITcc) en una cohorte de trabajadoras embarazadas del Parc de Salut Mar, Barcelona (España). Método: Estudio de cohorte retrospectiva de 428 trabajadoras embarazadas entre 2010 y 2014, que fueron seguidas hasta el parto, registrando las ausencias por ITcc o PRE hasta el inicio de su licencia por maternidad. El análisis de secuencias identifica cuatro trayectorias, que son descritas según las características demográficas y laborales de las trabajadoras. Resultados: Del total de mujeres, 56 (13,1%) accedieron únicamente a la PRE, que representó 6126 días de ausencia; 68 (15,9%) también accedieron a la PRE, con 7127 días de ausencia, pero con anterioridad habían acumulado 102 episodios de ITcc con 1820 días de ausencia. La mayoría de las trabajadoras embarazadas de la muestra (69,9%) se acogió solo a uno o varios episodios de ITcc sin utilizar la PRE, con 545 episodios y 26337 días de ausencia. La mayoría estuvieron activas laboralmente durante el primer trimestre y es a partir del segundo cuando aparecieron episodios de ITcc de larga duración. El último mes del embarazo, más del 80% de las trabajadoras estaban ausentes del trabajo. Conclusiones: Las trabajadoras embarazadas permanecen activas dos terceras partes del embarazo. Las ausencias se deben mayoritariamente a episodios de ITcc, representando la PRE una tercera parte. Nuestros resultados sugieren, como ocurre en otros países de nuestro entorno, un cambio en la gestión de la protección social de las trabajadoras embarazadas

Objective: To study the use of the Pregnancy occupational risk benefit (PORB) and non-work related sickness absence (NWSA) in a cohort of pregnant workers of Parc de Salut Mar, Barcelona (Spain). Method: Retrospective cohort study of 428 pregnant workers between 2010 and 2014, who were followed-up until delivery. Absences from work, both PORB and NWSA were recorded until the beginning of their maternity leave. The sequence analysis identifies four trajectories, which are described according to workers demographic and job characteristics. Results: Of the total cohort, 56 (13.1%) accessed only the PORB, representing 6.126 days of absence; 68 (15.9%) also accessed PORB, with 7.127 days of absence, but had previously accumulated 102 episodes of NWSA with 1.820 days of absence. The majority of pregnant workers in the sample (69.9%) took only one or several episodes of NWSA without using PORB, with 545 episodes and 26,337 days of absence. Most were active during the first quarter and it is from the second quarter that episodes of long-term NWSA appeared. During the last month of pregnancy more than 80% of the workers were absent from work. Conclusions: Pregnant workers remained at work for two thirds of their pregnancy. Absences were mainly due to episodes of NWSA. PORB represented one third of them. As in other similar countries, our results suggest a change in the management of social protection benefits for pregnant workers

Registrar para avanzar: algunas reflexiones sobre las lesiones por accidentes de trabajo / Recording to advance: thougts about injuries related to occupational accidents

No disponible

Working conditions and absence from work during pregnancy in a cohort of healthcare workers.

OBJECTIVES: To assess the relationship between exposure to occupational risk factors during pregnancy and absence from work using two different social benefits. METHOD: Three working pregnancy trajectories (WPT) were identified in a cohort of 428 pregnant workers from a healthcare institution (period 2010-2014), based on absence days and using cluster analysis. WPT1 included absences mainly covered by sickness absence benefit (32.0% of women), WPT2 included absences covered by pregnancy occupational risk (POR) benefit (28.3%) and WPT3 were pregnant workers with few absences (39.9%). Exposure to occupational risk factors was assessed by experts and association with trajectories was analysed using logistic regression. Relative risks (RR) and their 95% CIs were adjusted for age, type of contract and shift work. RESULTS: WPT2 was associated with exposure to physical (RR=1.86, 95%CI 1.17 to 2.97), safety (RR=2.10, 95%CI 1.61 to 2.73), ergonomic (RR=2.52, 95%CI 1.89 to 3.36) and psychosocial (RR=1.79, 95%CI 1.31 to 2.46) factors, and with exposure level. For physicians, WPT1 was associated with safety risks (RR=3.13, 95%CI 1.22 to 7.99), WPT2 with chemical and ergonomic for administrative/technical support (RR=12.20, 95%CI 1.69 to 88.09; RR=14.09, 95%CI 1.34 to 148.61, respectively), with safety and ergonomic risks for nursing aides (RR=1.84, 95%CI 1.12 to 3.02; RR=3.94, 95% CI 2.38 to 6.53, respectively), and with physical (RR=1.72, 95%CI 1.04 to 2.86), safety (RR=2.21, 95%CI 1.62 to 3.03), ergonomic (RR=2.02, 95%CI 1.44 to 2.86) and psychosocial factors (RR=1.96, 95%CI 1.32 to 2.90) for nurses. CONCLUSIONS: Absences from work covered by POR benefit show a consistent relationship with exposure to occupational risks. Sickness absence is the most frequent benefit used by pregnant workers. Current social benefits are apparently used adequately for protecting women from occupational exposures. Future studies are needed to clarify this further.

[Occupational risk during pregnancy and sick leave in a cohort of workers from Parc de Salut Mar (Barcelona, Spain)]. / Prestación por riesgo durante el embarazo e incapacidad temporal en una cohorte de trabajadoras del Parc de Salut Mar (Barcelona, España).

OBJECTIVE: To study the use of the Pregnancy occupational risk benefit (PORB) and non-work related sickness absence (NWSA) in a cohort of pregnant workers of Parc de Salut Mar, Barcelona (Spain). METHOD: Retrospective cohort study of 428 pregnant workers between 2010 and 2014, who were followed-up until delivery. Absences from work, both PORB and NWSA were recorded until the beginning of their maternity leave. The sequence analysis identifies four trajectories, which are described according to workers demographic and job characteristics. RESULTS: Of the total cohort, 56 (13.1%) accessed only the PORB, representing 6.126 days of absence; 68 (15.9%) also accessed PORB, with 7.127 days of absence, but had previously accumulated 102 episodes of NWSA with 1.820 days of absence. The majority of pregnant workers in the sample (69.9%) took only one or several episodes of NWSA without using PORB, with 545 episodes and 26,337 days of absence. Most were active during the first quarter and it is from the second quarter that episodes of long-term NWSA appeared. During the last month of pregnancy more than 80% of the workers were absent from work. CONCLUSIONS: Pregnant workers remained at work for two thirds of their pregnancy. Absences were mainly due to episodes of NWSA. PORB represented one third of them. As in other similar countries, our results suggest a change in the management of social protection benefits for pregnant workers.

Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital / Empleo inapropiado de catéteres urinarios en pacientes ingresados en servicios médicos en un hospital universitario

INTRODUCTION: The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. Methods A cross-sectional study was conducted including all patients aged ¡Ý18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. Results Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. Conclusions Further educational efforts should be focused on improving catheterization prescribing practices by physicians

INTRODUCCIÓN: Pretendemos analizar la prevalencia y los factores asociados al empleo inapropiado de catéteres urinarios (CU) en los servicios médicos. MÉTODOS: Realizamos un estudio de corte transversal que incluyó a todos los pacientes (≥ 18 años) ingresados en servicios médicos de un centro de tercer nivel de 1.300 camas y que eran portadores de CU el día de la observación. Resultados: De los 380 pacientes observados, 46 (12,1%) eran portadores de un CU. La cateterización fue juzgada inapropiada en 12 de ellos (26,1%). El motivo más habitual para el uso inapropiado de CU fue la monitorización de la diuresis en un paciente colaborador y no crítico. El uso inapropiado de CU se asoció con la edad, la situación funcional, la presencia de incontinencia urinaria, el diagnóstico de demencia y la institucionalización previa. Conclusiones: Es preciso mejorar los hábitos de prescripción de CU mediante esfuerzos educativos específicos

Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital.

INTRODUCTION: The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. METHODS: A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. RESULTS: Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. CONCLUSIONS: Further educational efforts should be focused on improving catheterization prescribing practices by physicians.

Baja adhesión a un programa de vacunación contra la gripe A (H1N1) pandémica 2009 entre el personal sanitario de una institución durante la fase de pandemia / Lowadherence to 2009 pandemic influenza A(H1N1)vaccination programamong

Introducción: Se han diseñado diversas estrategias para aumentar la adhesión a los programas de vacunación dirigidos al personal sanitario, aunque con resultados no siempre satisfactorios. Material y métodos: Se analizaron las diferencias entre la adhesión a la vacunación contra las gripes estacional y A pandémica tras la realización de un programa de vacunación. Se identificaron los factores predictores de adhesión a la vacuna pandémica, así como sus efectos adversos mediante un cuestionario electrónico de seguimiento. Resultados: Un 7,6% de profesionales se vacunaron contra la gripe A (H1N1) pandémica y un 33,7%contra la estacional. Para ambas vacunas se observaron diferencias estadísticamente significativas entre el personal vacunado y el no vacunado, según edad, categoría profesional y centro de trabajo, mientras que en el sexo sólo para la pandémica. Hubo una mayor proporción de vacunados contra la gripe A (H1N1)pandémica en varones, mayores de 55 años, técnicos superiores asistenciales y de hospital de agudos. En el modelo multivariado, que mostró una muy buena capacidad discriminatoria (AUC curva ROC= 0,843),la edad, la categoría profesional, el centro de trabajo y la vacunación previa contra la gripe estacional fueron factores predictores de vacunación de la gripe A (H1N1) pandémica. El principal motivo de esta vacunación fue la protección de los pacientes. El efecto adverso más frecuente fue el dolor en el punto deinyección. Conclusiones: La adhesión al programa de vacunación contra la gripe A (H1N1) pandémica fue muy baja, lo que sugiere la necesidad de implantar nuevas estrategias en los programas de vacunación. El principal motivo de vacunación fue la protección de los pacientes. La tolerabilidad de la vacuna fue buena (AU)

Introduction: Several strategies have been designed to increase adherence to vaccination programs aimed at health professionals, though the results were not always satisfactory. Material and methods: The differences between adherence to seasonal and pandemic influenza vaccination were assessed after the implementation of a vaccination program, and the predicting factors of adherence to the pandemic vaccine were identified. The adverse effects of this vaccine were analysed by means of a follow up e-questionnaire. Results: The results revealed that 7.6% of professionals were vaccinated against pandemic influenza, and 33.7% against seasonal influenza. Statistically significant differences were observed for both vaccines when comparing vaccinated to unvaccinated professionals for age, professional category and workplace, while sex differences were only related to pandemic influenza. The highest rate of pandemic influenza vaccination was found among men older than 55 years old working as physicians in acute care hospitals. In the multivariate model, which showed a very good discriminatory power (Area under ROC curve = 0.843), age, professional category, workplace and previous vaccination against seasonal influenza were independent predicting factors of vaccination against pandemic influenza. The main reason for vaccination was patient protection. The most frequent adverse effect was pain in the injection area. Conclusions: Adherence to pandemic influenza vaccination program was very low, which suggests the need to implement new strategies into vaccination programs. The main reason for vaccination was patient protection. The tolerability of the pandemic vaccine was good (AU)

[Low adherence to 2009 pandemic influenza A(H1N1) vaccination program among health care workers of a medical centre during the pandemic phase]. / Baja adhesión a un programa de vacunación contra la gripe A (H1N1) pandémica 2009 entre el personal sanitario de una institución durante la fase de pandemia.

INTRODUCTION: Several strategies have been designed to increase adherence to vaccination programs aimed at health professionals, though the results were not always satisfactory. MATERIAL AND METHODS: The differences between adherence to seasonal and pandemic influenza vaccination were assessed after the implementation of a vaccination program, and the predicting factors of adherence to the pandemic vaccine were identified. The adverse effects of this vaccine were analysed by means of a follow up e-questionnaire. RESULTS: The results revealed that 7.6% of professionals were vaccinated against pandemic influenza, and 33.7% against seasonal influenza. Statistically significant differences were observed for both vaccines when comparing vaccinated to unvaccinated professionals for age, professional category and workplace, while sex differences were only related to pandemic influenza. The highest rate of pandemic influenza vaccination was found among men older than 55 years old working as physicians in acute care hospitals. In the multivariate model, which showed a very good discriminatory power (Area under ROC curve=0.843), age, professional category, workplace and previous vaccination against seasonal influenza were independent predicting factors of vaccination against pandemic influenza. The main reason for vaccination was patient protection. The most frequent adverse effect was pain in the injection area. CONCLUSIONS: Adherence to pandemic influenza vaccination program was very low, which suggests the need to implement new strategies into vaccination programs. The main reason for vaccination was patient protection. The tolerability of the pandemic vaccine was good.