Are Spanish adolescents who actively commute to and from school more active in other domains? A spatiotemporal investigation.

We examined the association between mode of commuting to/from school (i.e., walking, multimodal, and motorized-vehicle) and movement behaviours in several space-time domains (i.e., total day, home, school, transport, and other locations). Walking to and/or from school was associated with higher MVPA in all space-time domains except home, where no associations were found. After subtracting commuting time to/from school from total day domain, the associations in favour of walking to/from school were maintained compared to those using other commuting modes, and in transport domain these associations dissipated. The study suggests the importance of promoting walking to/from school for increasing MVPA levels.

Parent's sociodemographic factors, physical activity and active commuting are predictors of independent mobility to school.

BACKGROUND: Independent mobility (IM) provides young people with many opportunities to increase their autonomy and physical activity (PA). This study aimed to analyse whether the parent's PA, active commuting to work and sociodemographic factors serve as predictors of IM to school in children and adolescents. METHODS: A total of 684 parents (52.8% mothers) and their offspring (56.4% girls) were included in this study, which was performed in Granada (Spain) and Valparaíso (Chile). The parents self-reported their sociodemographic characteristics, PA and mode of commuting to work. The mode of commuting to and from school and the offspring accompaniment mode were reported. T-test and chi-square test were used to study quantitative and qualitative differences by parental gender, respectively. Binary logistic regression models (odds ratio = OR) and stepwise analysis were performed to study the association between the parents' sociodemographic variables and IM to school. RESULTS: Adolescents showed higher IM to school than children (58.9% vs 40.2%; p < 0.001). No car availability and shorter distance to work were positively associated with higher IM to school in children (OR = 2.22 and 2.29, respectively). Mothers' lower salary/month (OR = 2.75), no car availability (OR = 3.17), and mother passive commuting to work (OR = 2.61) were positively associated with higher IM to school in adolescents. The main predictor of IM to school in children and adolescents was no car availability (OR = 6.53). CONCLUSION: Parental sociodemographic factors, such as salary, distance to work and car availability, were associated more strongly with IM than parental PA and active commuting to work.

Estudio de biocompatibilidad y osteointegración de nuevos materiales protésicos / Biocompatibility and osseointegration study of new prosthetic materials

OBJETIVO: Los implantes óseos son utilizados cada vez con mayor frecuencia en la práctica clínica y, entre los materiales, el Ti o sus aleaciones son los de mejor rendimiento por sus propiedades fisicoquímicas. Aleaciones como TiNbTa han demostrado mejorar las características biomecánicas del Ti puro comercial (c.p.), sin embargo, su capacidad osteointegradora necesita ser evaluada. El objetivo del presente estudio fue valorar la citotoxicidad y la capacidad de adhesión, proliferación y diferenciación de células osteoblásticas en cultivo, influida por discos de material TiNbTa frente a Ti c.p. MATERIALES Y MÉTODOS: Analizamos a los 4 y 7 días del cultivo la línea celular MC3T3, la viabilidad celular (AlamarBlue Cell Viability Reagent. Invitrogen, España), así como la proliferación y diferenciación celular (actividad de fosfatasa alcalina (ALP) y microscopía electrónica de barrido (Fijación para SEM). Se realizó la prueba t de Student para determinar diferencias estadísticamente significativas entre los dos grupos de discos de estudio. RESULTADOS: Los resultados obtenidos demuestran muy buena viabilidad celular durante el periodo de estudio, sin diferencias significativas para ambos materiales. Así mismo, detectamos una caída en los niveles de ALP que fue significativa para ambos componentes entre los días 4 y 7 del estudio (p < 0,05). Las imágenes de microscopía electrónica revelaron buena capacidad de adhesión al material, así como diferenciación celular frente a ambos tipos de discos. CONCLUSIONES: La aleación de TiNbTa como material para implantes óseos cuenta con una buena capacidad osteointegradora, además de resolver problemas de biomecánica que presenta el titanio puro como componente

OBJETIVE: Bone implants are increasingly used in clinical practice and, among the materials, Ti or its alloys are offer the best performance given their physicochemical properties. Alloys such as TiNbTa have been shown to improve the biomechanical characteristics of commercial pure Ti (c.p.), however, its osseointegration capacity needs to be evaluated. The objective of the present study was to assess the cytotoxicity and the adhesion, proliferation and differentiation capacity of osteoblastic cells in culture, influenced by discs of TiNbTa material versus Ti c.p. MATERIAL AND METHODS: At 4 and 7 days after culture, we analyzed the MC3T3 cell line, cell viability (AlamarBlue Cell Viability Reagent. Invitrogen, Spain), as well as cell proliferation and differentiation (alkaline phosphatase activity (ALP) and scanning electron microscopy (Fixation for SEM) Student's t test was performed to determine statistically significant differences between the two groups of study discs. RESULTS: The results obtained show very good cell viability during the study period, with no significant differences for both materials. Likewise, we detected a drop in ALP levels that was significant for both components between days 4 and 7 of the study (p < 0.05). Electron microscopy images revealed good adhesion capacity to the material, as well as cell differentiation against both types of discs. CONCLUSIONS: The TiNbTa alloy as a material for bone implants offers good osseointegrative capacity, in addition to solving biomechanical problems that pure titanium presents as a component

Bed 13 is not worse than any other. A retrospective cohort study.

INTRODUCTION: Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS: A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS: A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2). CONCLUSIONS: Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

A new and simple scoring system to predict overall survival after irradiation for metastatic spinal cord compression.

PURPOSE: To develop a model that predicts survival in patients irradiated for metastatic spinal cord compression (MSCC), hence assisting in the decision between a short and a long-course radiotherapy (RT) regimen. METHODS: 138 patients diagnosed with MSCC and treated with RT alone were included. Based on a multivariate analysis, a scoring system was developed. It included four prognostic variables: age, number of vertebrae, ECOG and histology. Total scores ranged between 14 and 24 points and patients were divided into two groups. RESULTS: The 6-month survival rate was 22% for patients with a score of 14-18 points; and 69% for patients with a score of 19-24 points (P < 0.001). The system exhibits a high specificity and positive predictive value and an appropriate discriminative ability. CONCLUSIONS: Patients with scores between 19 and 24 points were found to survive longer, thus a long-course RT appears to be more appropriate.

Parental barriers to active transport to school: a systematic review.

OBJECTIVES: We aimed to systematically review parental barriers towards children and adolescents' active transport to school (ATS) in the scientific literature and to provide a categorization of the barriers identified in the studies. METHODS: A search was conducted through seven online databases, from the beginning of the database to March 2018. RESULTS: A total of 27 of the identified studies met the inclusion criteria. The main parental barriers reported by parents of children (21 studies) were built environment, traffic safety, distance, crime-related safety and social support. The main parental barriers reported by parents of adolescents (6 studies) were built environment (street connectivity), distance, traffic safety and physical and motivation barriers. The parental barriers associated with ATS were mainly related to the built environment and traffic safety. CONCLUSIONS: It is crucial to involve parents through interventions to reduce the perception of safety and to increase awareness of the importance of ATS. In addition, these strategies should be complemented by environmental changes performed by local governments.

Association of sedentary time and physical activity with pain, fatigue, and impact of fibromyalgia: the al-Ándalus study.

We examined the association of objectively measured sedentary time (ST) and physical activity (PA) levels with pain, fatigue, and the impact of the disease in women with fibromyalgia. Four hundred and nineteen (mean age ± SD = 51.7 ± 7.6 years old) women with fibromyalgia participated. ST and PA levels (light, moderate, and moderate-to-vigorous [MVPA]) were measured with triaxial accelerometry. We assessed experimental pain with algometry and clinical pain, fatigue, and impact of fibromyalgia with a number of questionnaires. The association of ST and light PA with most of the pain- and fatigue-related outcomes and impact of fibromyalgia (all, P ≤ 0.019) was independent of moderate and vigorous PA. Furthermore, the association of vigorous PA with general and physical fatigue was independent of ST and light and moderate PA (all, P < 0.001). In conclusion, lower levels of ST or higher levels of light PA are associated with lower pain, fatigue, and the overall impact of the disease independent of moderate and vigorous PA in women with fibromyalgia. Interestingly, higher vigorous PA is independently associated with lower general and physical fatigue. These results are significant for future ST and PA intervention studies in this population.

Physical fitness reference standards in fibromyalgia: The al-Ándalus project.

We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P < 0.001) in all age ranges (P < 0.001). This study provides a comprehensive description of age-specific physical fitness levels among patients with fibromyalgia and controls in a large sample of patients with fibromyalgia from southern of Spain. Physical fitness levels of people with fibromyalgia from Andalusia are very low in comparison with age-matched healthy controls. This information could be useful to correctly interpret physical fitness assessments and helping health care providers to identify individuals at risk for losing physical independence.

Barcodes of marine invertebrates from north Iberian ports: Native diversity and resistance to biological invasions.

Ports are gateways for many marine organisms transported by ships worldwide, especially non-indigenous species (NIS). In this study carried out in North Iberian ports (Cantabrian Sea, Bay of Biscay) we have observed 38% of exotic macroinvertebrates. Four species, namely the barnacle Austrominius modestus, the tubeworm Ficopomatus enigmaticus, the Pacific oyster Crassostrea gigas and the pygmy mussel Xenostrobus securis, exhibited clear signs of invasiveness. A total of 671 barcode (cytochrome oxidase subunit I or 18S rRNA) genes were obtained and confirmed the species status of some cryptic NIS. Negative and significant correlation between diversity estimators of native biota and proportion of NIS suggests biotic resistance in ports. This could be applied to management of port biota for contributing to prevent the settlement of biopollutants in these areas which are very sensitive to biological invasions.

Response of top shell assemblages to cyclogenesis disturbances. A case study in the Bay of Biscay.

Cyclones and other climate disturbances profoundly affect coastal ecosystems, promoting changes in the benthic communities that require time, sometimes even years, for a complete recovery. In this study we have analysed the morphological and genetic changes occurred in top shell (Gibbula umbilicalis and Phorcus lineatus) assemblages from the Bay of Biscay following explosive cyclogenesis events in 2014. Comparison with previous samples at short (three years before the cyclogenesis) and long (Upper Pleistocene) temporal scales served to better evaluate the extent of change induced by these disturbances in a more global dimension. A significant increase in mean size after the cyclogenesis was found for the two species, suggesting selective sweeping of small individuals weakly adhered to substrata. Loss of haplotype variants at the cytochrome oxidase subunit I gene suggests a population bottleneck, although it was not intense enough to produce significant changes in haplotype frequencies. The high population connectivity and metapopulation structuring of the two species in the area likely help the populations to recover from disturbances. At a wider temporal scale, cyclogenesis effects seemed to compensate the apparent decreasing trends in size for P. lineatus occurred after the Pleistocene-Holocene transition. Considering disturbance regimes for population baselines is recommended when the long-term effects of climate and anthropogenic pressures are evaluated.

El ritual de la falta de camas / The ritual of the lack of beds

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Reflex seizures in Rett syndrome.

Reflex seizures are a rare phenomenon among epileptic patients, in which an epileptic discharge is triggered by various kinds of stimuli (visual, auditory, tactile or gustatory). Epilepsy is common in Rett syndrome patients (up to 70%), but to the authors' knowledge, no pressure or eating-triggered seizures have yet been reported in Rett children. We describe three epileptic Rett patients with reflex seizures, triggered by food intake or proprioception. One patient with congenital Rett Sd. developed infantile epileptic spasms at around seven months and two patients with classic Rett Sd. presented with generalised tonic-clonic seizures at around five years. Reflex seizures appeared when the patients were teenagers. The congenital-Rett patient presented eating-triggered seizures at the beginning of almost every meal, demonstrated by EEG recording. Both classic Rett patients showed self-provoked pressure -triggered attacks, influenced by stress or excitement. Non-triggered seizures were controlled with carbamazepine or valproate, but reflex seizures did not respond to antiepileptic drugs. Risperidone partially improved self-provoked seizures. When reflex seizures are suspected, reproducing the trigger during EEG recording is fundamental; however, self-provoked seizures depend largely on the patient's will. Optimal therapy (though not always possible) consists of avoiding the trigger. Stress modifiers such as risperidone may help control self-provoked seizures.

Utilidad de la ecografía pulmonar en la unidad de medicina intensiva / Utility of the lung ultrasound in the intensive medicine unit

Tradicionalmente, el abordaje diagnóstico por la imagen del tórax en el paciente crítico se ha basado en la radiografía simple anteroposterior. Sin embargo, esta presenta grandes limitaciones en la precisión diagnóstica de la enfermedad pleuropulmonar. La introducción de la tomografía axial computarizada resolvió en gran medida este problema, pero con el doble inconveniente de las dosis de radiación y del inevitable traslado fuera de la unidad de cuidados intensivos. En este contexto, la ecografía pulmonar, gracias a su portabilidad, se convierte en una técnica alternativa en determinadas situaciones, con la ventaja de realizarse a la cabecera de los pacientes, ser fácilmente reproducible y no administrar radiaciones ionizantes. En la ecografía pulmonar, las costillas, la columna vertebral y el aire del pulmón actúan como barreras para los ultrasonidos, y provocan artefactos que debemos reconocer e interpretar para un correcto diagnóstico. No obstante, las enfermedades intratorácicas y la existencia de líquido en el espacio pleural, así como la consolidación o atelectasia en el pulmón proporcionan suficiente ventana ecográfica para una correcta evaluación. En la siguiente revisión abordaremos los aspectos principales de la realización de la técnica de la ecografía pulmonar, definiremos el patrón normal y los artefactos que sirven de base para la detección de anormalidades, y explicaremos los criterios de los patrones de las principales enfermedades (consolidación, derrame pleural, edema de pulmón y neumotórax). También discutiremos la posible utilidad y las limitaciones que la ecografía pulmonar puede tener en diferentes situaciones de nuestra práctica clínica, como en el diagnóstico de la insuficiencia respiratoria aguda; la detección, la cuantificación y el drenaje del derrame pleural; el traumatismo torácico; las complicaciones y el tratamiento del sídrome de distrés respiratorio agudo, y la comprobación de una correcta intubación traqueal (AU)

The radiological diagnostic approach of the thorax in the critically ill patient has traditionally been based on the anteroposterior chest X-ray. However, it is generally accepted that it has important limitations regarding its diagnostic accuracy of pleuro-pulmonary disease. The introduction of computed tomography largely solved this problem, but with the dual disadvantage of a larger radiation dose and the unavoidable transportation outside of the ICU. In this context, the lung ultrasound has become an alternative technique, with the advantage that due to its portability, it is done at the patient's bedside. In the lung ultrasound, the ribs, spine and air in the thorax act as barriers to the ultrasounds, causing artifacts that must be recognized and interpreted for a correct diagnosis. However, intrathoracic diseases, existence of fluid in the pleural space and consolidation, or atelectasis in the lung provide a sufficient ultrasound window for the correct evaluation. In this review, we explain the lung and pleural ultrasound technique, define the normal pattern and the artifacts that serve to detect the abnormalities and we explain the criteria for the main diseases (consolidation, pleural effusion, pulmonary edema and pneumothorax). We also discuss the possible utility and limitations of the lung ultrasound in our daily practice, such as diagnosis of acute respiratory failure, detection, quantification and drainage of a pleural effusion, chest trauma, management and complications of acute respiratory distress syndrome and tracheal intubation success or failure (AU)

[Utility of the lung ultrasound in the intensive medicine unit]. / Utilidad de la ecografía pulmonar en la unidad de medicina intensiva.

The radiological diagnostic approach of the thorax in the critically ill patient has traditionally been based on the anteroposterior chest X-ray. However, it is generally accepted that it has important limitations regarding its diagnostic accuracy of pleuro-pulmonary disease. The introduction of computed tomography largely solved this problem, but with the dual disadvantage of a larger radiation dose and the unavoidable transportation outside of the ICU. In this context, the lung ultrasound has become an alternative technique, with the advantage that due to its portability, it is done at the patient's bedside. In the lung ultrasound, the ribs, spine and air in the thorax act as barriers to the ultrasounds, causing artifacts that must be recognized and interpreted for a correct diagnosis. However, intrathoracic diseases, existence of fluid in the pleural space and consolidation, or atelectasis in the lung provide a sufficient ultrasound window for the correct evaluation. In this review, we explain the lung and pleural ultrasound technique, define the normal pattern and the artifacts that serve to detect the abnormalities and we explain the criteria for the main diseases (consolidation, pleural effusion, pulmonary edema and pneumothorax). We also discuss the possible utility and limitations of the lung ultrasound in our daily practice, such as diagnosis of acute respiratory failure, detection, quantification and drainage of a pleural effusion, chest trauma, management and complications of acute respiratory distress syndrome and tracheal intubation success or failure.

Consumo de tabaco en pacientes hospitalizados antes y después de la Ley antitabaco (28/2005) / Tobacco consumption in hospitalized patients before and after the anti-tobacco law (28/2005)

ObjetivosConocer la prevalencia del consumo de tabaco en fumadores durante un ingreso hospitalario y determinar las variables asociadas con dicho consumo. Analizar si se han producido cambios en la prevalencia tras la entrada en vigor de la ley antitabaco 28/2005.Material y métodosEstudio transversal de casos consecutivos en la población ingresada en un hospital, antes y después de la entrada en vigor de la citada ley. Se encuestaron 1189 enfermos, de los cuales 184 (15,4%) se declararon fumadores activos a su llegada al hospital. De estos, 135 (73,3%) aceptaron participar en el estudio. Entre las 72–96h tras su admisión, completaron una encuesta que incluía datos sobre su hábito tabáquico, situación social y consumo de tabaco durante el ingreso. Se realizó una medición del monóxido de carbono en aire espirado utilizando un cooxímetro. Se consideraron como fumadores dentro del hospital los pacientes que admitieron haber fumado durante su estancia hospitalaria y/o aquellos en los que el resultado de la cooximetría fue mayor de 6ppm.ResultadosDe los 135 pacientes que completaron el estudio, 53 (39,3%) fumaron durante el ingreso, antes de la ley 34,2% (IC 95%: 22,6–45,8%) y después de la ley 45,1% (IC 95%: 31,9–58,3%). No hallamos diferencias significativas en los 2 años de recogida de datos (p=0,26). Las variables que de forma independiente se asociaron al consumo de tabaco durante la estancia hospitalaria fueron: vivir solo/sin pareja (p=0,015, OR 2,85, IC 95% 1,22–6,65), test de Richmond menor o igual a 7 (p=0,002, OR 3,64, IC 95% 1,60–8,31) y puntuación en la variable «ganas de fumar» mayor o igual a 2 (p<0,001, OR 4,85, IC 95% 2,08–11,28). Mediante la valoración de estos parámetros se puede determinar la probabilidad de que un paciente fume durante el ingreso hospitalario (79,3% si el paciente vive solo, test de Richmond <7 y encuesta sobre «ganas de fumar» <2...(AU)

ObjectivesTo know the prevalence of tobacco consumption in smokers during a hospital say and determine the variables associated with this consumption. To analyze if changes have occurred in its prevalence after the entry into force of the anti-tobacco law 28/2005.Material and methodsA cross-sectional study of consecutive cases in the population admitted to a hospital before and after the entry into force of said law. A total of 1189 patients were surveyed. Of these 184 (15.4%) stated they were active smokers when the arrived to the hospital. A total of 135 (73.3%) of these accepted to participate in the study. Between 72 and 96 hours after their admission, they filled out a survey that included data on the smoking habit, social status and consumption of tobacco during their hospital stay. Carbon monoxide in the expired air was measured with a cooximeter. Smokers within the hospital were considered to be those patients who admitted having smoked during their hospital stay and/or those in whom the cooximeter result was greater than 6ppm.ResultsOf the 135 patients who completed the study, 53 (39.3%) smoked during their stay, 34.2% (95% CI: 22.6&%#x02013;45.8%) before the law and 45.1% (95% CI: 31.9&%#x02013;58.3%) after the law. No significant differences were found during the 2 years in which the data were collected (p=0.26). The variables which were independently associated to tobacco consumption during the hospital stay were: living along/without a partner (p=0.015, OR 2.85, 95% CI 1.22–6.65), Richmond test less than or equal to 7 (p=0.002, OR 3.64, 95% CI 1.60–8.31) and score on the variable “desire to smoke” greater than or equal to 2 (p<0.001, OR 4.85, 95% CI 2.08–11.28). Based on the evaluation of these parameters, the likelihood that a patient would smoke during the hospital stay can be determined (79.3% if the patient lives along, Richmond test <7 and survey on "desire to smoke” <2)...(AU)

[Tobacco consumption in hospitalized patients before and after the anti-tobacco law (28/2005)]. / Consumo de tabaco en pacientes hospitalizados antes y después de la Ley antitabaco (28/2005).

OBJECTIVES: To know the prevalence of tobacco consumption in smokers during a hospital say and determine the variables associated with this consumption. To analyze if changes have occurred in its prevalence after the entry into force of the anti-tobacco law 28/2005. MATERIAL AND METHODS: A cross-sectional study of consecutive cases in the population admitted to a hospital before and after the entry into force of said law. A total of 1189 patients were surveyed. Of these 184 (15.4%) stated they were active smokers when the arrived to the hospital. A total of 135 (73.3%) of these accepted to participate in the study. Between 72 and 96 hours after their admission, they filled out a survey that included data on the smoking habit, social status and consumption of tobacco during their hospital stay. Carbon monoxide in the expired air was measured with a cooximeter. Smokers within the hospital were considered to be those patients who admitted having smoked during their hospital stay and/or those in whom the cooximeter result was greater than 6ppm. RESULTS: Of the 135 patients who completed the study, 53 (39.3%) smoked during their stay, 34.2% (95% CI: 22.6%-45.8%) before the law and 45.1% (95% CI: 31.9%-58.3%) after the law. No significant differences were found during the 2 years in which the data were collected (p=0.26). The variables which were independently associated to tobacco consumption during the hospital stay were: living along/without a partner (p=0.015, OR 2.85, 95% CI 1.22-6.65), Richmond test less than or equal to 7 (p=0.002, OR 3.64, 95% CI 1.60-8.31) and score on the variable "desire to smoke" greater than or equal to 2 (p<0.001, OR 4.85, 95% CI 2.08-11.28). Based on the evaluation of these parameters, the likelihood that a patient would smoke during the hospital stay can be determined (79.3% if the patient lives along, Richmond test <7 and survey on "desire to smoke" <2). CONCLUSIONS: Tobacco consumption continues to be an important problem in the medical departments of the hospitals. Through the evaluation of 3 simple variables, it is possible to determine if a patient will smoke during the hospitalization.

Factores pronósticos de mortalidad en una cohorte de pacientes con parada cardiorrespiratoria hospitalaria / Prognostic factors of mortality in a cohort of patients with in-hospital cardiorespiratory arrest

Objetivo: Definir los factores pronósticos en relación con la mortalidad de los pacientes que tienen una parada cardiorrespiratoria (PCR) hospitalaria, ajustándose al estilo Utstein. Diseño: Registro descriptivo y prospectivo durante un período de 30 meses de los pacientes que tuvieron un episodio de PCR hospitalaria. Análisis multivariante mediante regresión de Cox para identificar los factores independientes asociados a la mortalidad. Ámbito: Hospitalario, Hospital General del Complejo Universitario Virgen de las Nieves. Pacientes: Todos los pacientes atendidos por una PCR en el hospital, excepto las ocurridas en las áreas de quirófanos y reanimación. Seguimiento hasta el alta hospitalaria, sin pérdidas. Variable de principal interés: mortalidad al alta hospitalaria. Resultados: Se registraron 203 pacientes que tuvieron al menos una PCR en el hospital, de los cuales el 60,6% fueron hombres (123 pacientes) con una mediana de edad de 67 años. La localización más frecuente fue en la unidad de medicina intensiva (48%) y el origen fue cardiológico (62%). Se obtuvo una supervivencia hospitalaria del 23,15%. En el análisis multivariante los factores independientemente asociados a la mortalidad hospitalaria fueron el uso de adrenalina (hazard ratio [HR]: 3,4; IC del 95%: 1,6-7), la duración total de la reanimación (HR: 1,018; IC del 95%: 1,012-1,024) y, como protectores, el primer ritmo en fibrilación ventricular/taquicardia ventricular sin pulso (HR: 0,6; IC del 95%: 0,4-0,9) y la presencia de un testigo médico (HR: 0,6; IC del 95%: 0,5-0,9). Conclusiones: Entre los factores asociados a la mortalidad tras un episodio de PCR hospitalaria se identificó el tipo de testigo. La relevancia de este hecho radica en que la cualificación del personal sanitario es un factor modificable mediante el entrenamiento adecuado (AU)

Objective: To define the prognostic factors related with mortality of patients who suffer cardiorespiratory arrest (CRA) in the hospital, according to Utstein style guidelines. Design: A descriptive and prospective study covering a 30-month consecutive period of all the patients who suffered at least one episode of in-hospital CRA. A Cox regression multivariate analysis was made to identify the independent factors associated with mortality. Setting: A medical-surgical center in Hospital «Virgen de las Nieves» (HUVN), Granada (Spain). Patients: All the patients attended due to CRA in the hospital, except for those occurring in the operating and recovery room areas. They were followed-up to hospital discharge. Main variables: Mortality on hospital discharge. Results: 203 patients who suffered at least one cardiorespiratory arrest in the hospital, with a median age of 67 years and preponderance of male (60.6%). The most common location was in intensive care medicine unit (48%) and cardiac etiology (62%). Hospital survival rate was 23.15%. In multivariate analysis, strong predictors of mortality were administration of any dose of epinephrine during resuscitation maneuvers (OR 3.4; CI 95%. 1.6-7), total duration of resuscitation (HR 1.018; CI 95%, 1.012-1.024) and as protective factors the first ventricular fibrillation/ventricular tachycardia rhythm with no pulse (HR 0.6; CI 95%, 0.4-0.9) and witnessed by a doctor (HR 0.6; CI 95%, 0.5-0.9). Conclusions: The type of witness was identified among the predictors of mortality on hospital discharge after an episode of cardiac arrest. This becomes important because the qualification of healthcare personnel can be improved through adequate training (AU)