Brote por virus respiratorio sincitial en la Unidad de Neonatología de un hospital de tercer nivel / Bedside ultrasound in the critically ill paediatric patient

INTRODUCCIÓN: Investigación y control de un brote por virus respiratorio sincitial (VRS) que afectó a la Unidad de Neonatología (UN) de un hospital universitario de octubre a diciembre del 2012. PACIENTES Y MÉTODOS: Estudio de cohortes de los niños ingresados en la UN. Se calculó la tasa de ataque de infección y se realizaron un análisis descriptivo de los casos y un análisis multivariante de aquellas variables que mostraron ser factores de riesgo de infección por VRS. Las medidas preventivas llevadas a cabo fueron: aislamiento de contacto de casos; formación y observación de higiene de manos; exclusividad del personal sanitario para casos, restricción de visitas; estudio de portadores de VRS y profilaxis con palivizumab. RESULTADOS: El brote tuvo 3 ondas epidémicas y un total de 20 casos, de 48 niños ingresados. La tasa de ataque global fue del 42%. De los casos, la mitad fueron niños, con una edad mediana de 36 días (p25=22, p75=58). El peso al nacimiento inferior a 1.000 g (OR=23,5; p = 0,002) y tener otra infección nosocomial en la semana previa al diagnóstico de infección por VRS (OR=19,98; p = 0,016), fueron factores de riesgo independientes de infección por VRS. CONCLUSIONES: Se trató de un brote epidémico con un elevado número de casos, relacionado con el retraso en la notificación, el tiempo prolongado del estado de portador del VRS y los fallos en el cumplimiento de la higiene de manos, que favoreció la transmisión cruzada de la infección. Las medidas preventivas más eficaces fueron la observación directa de higiene de manos y supervisión de las medidas de aislamiento

INTRODUCTION: Investigation and control of a respiratory syncytial virus (RSV) outbreak that affected the Neonatal Intensive Care Unit (NICU) of a university hospital from October to December 2012. PATIENTS AND METHODS: Cohort study of children admitted to the NICU. The infection attack rate was calculated. A descriptive analysis of the cases and a multivariate analysis was performed using the variables that were shown to be risk factors for RSV infection. Preventive measures taken were: contact isolation; hand hygiene training and observation; exclusivity of a health team of nurses and physicians for positive cases, restrictions on visitor numbers; surveillance RSV testing, and palivizumab prophylaxis. RESULTS: The outbreak had three epidemic waves and 20 positive cases out of a total of 48 children admitted. The overall attack rate was 42%. Half of positive cases were children, with a median age of 36 days (p25=22, p75=58). The independent risk factors for RSV infection were birth weight below 1000 grams (OR=23.5; P=.002) and to have another nosocomial infection the week before the diagnosis of RSV infection (OR=19.98; P=.016). CONCLUSIONS: It was an outbreak with a high number of cases, due to the delay in notification, prolonged RSV carrier status, and low adherence to hand hygiene practice, which favoured the cross-transmission of infection. The most effective preventive measures were direct observation of hand hygiene and supervision of isolation measures

[Respiratory syncytial virus outbreak in a tertiary hospital Neonatal Intensive Care Unit]. / Brote por virus respiratorio sincitial en la Unidad de Neonatología de un hospital de tercer nivel.

INTRODUCTION: Investigation and control of a respiratory syncytial virus (RSV) outbreak that affected the Neonatal Intensive Care Unit (NICU) of a university hospital from October to December 2012. PATIENTS AND METHODS: Cohort study of children admitted to the NICU. The infection attack rate was calculated. A descriptive analysis of the cases and a multivariate analysis was performed using the variables that were shown to be risk factors for RSV infection. Preventive measures taken were: contact isolation; hand hygiene training and observation; exclusivity of a health team of nurses and physicians for positive cases, restrictions on visitor numbers; surveillance RSV testing, and palivizumab prophylaxis. RESULTS: The outbreak had three epidemic waves and 20 positive cases out of a total of 48 children admitted. The overall attack rate was 42%. Half of positive cases were children, with a median age of 36 days (p25=22, p75=58). The independent risk factors for RSV infection were birth weight below 1000 grams (OR=23.5; P=.002) and to have another nosocomial infection the week before the diagnosis of RSV infection (OR=19.98; P=.016). CONCLUSIONS: It was an outbreak with a high number of cases, due to the delay in notification, prolonged RSV carrier status, and low adherence to hand hygiene practice, which favoured the cross-transmission of infection. The most effective preventive measures were direct observation of hand hygiene and supervision of isolation measures.

Hospital costs associated with nosocomial infections in a pediatric intensive care unit / Coste asociado a la infección nosocomial en una unidad de cuidados intensivos pediátricos

Objective: To estimate the additional cost attributable to nosocomial infection (NI) in a pediatric intensive care unit (PICU) and related factors. Methods: A prospective cohort study was conducted in all children admitted to the PICU of a tertiary-care pediatric hospital between 2008 and 2009. Descriptive and bivariate analyses were conducted of total direct costs due to PICU stay and medical procedures in patients with and without NI. A log-linear regression model was performed to determine the factors associated with higher total cost. Results: A total of 443 patients were studied and the prevalence of NI was 11.3%. The difference in the median total cost was €30,791.4 per patient between groups with and without NI. The median cost of PICU length of stay in patients with NI was almost eight times higher than the median cost of patients without NI. In patients with NI, the highest costs related to medical procedures were associated with antibiotics, enteral and parenteral feeding, and imaging tests. In the multivariate model, the factors associated with higher cost were infection, the performance of cardiovascular surgery, urgent admission, a higher pediatric risk mortality score, and the presence of immunosuppression. By contrast, older children and those with surgical admission generated lower cost. Conclusions: NI was associated with an increase in total cost, which implies that the prevention of these infections through specific interventions could be cost-effective and would help to increase the safety of healthcare systems (AU)

Objetivo: El objetivo del estudio es estimar el coste adicional atribuible a la infección nosocomial (IN) en una Unidad Pediátrica de Cuidados Intensivos (UCIP) y sus factores asociados. Método: estudio de cohortes prospectivo de todos los pacientes ingresados en una UCIP de tercer nivel entre 2008 y 2009. Se realizó un análisis descriptivo y bivariante del coste total asociados a estancia en UCIP y procedimientos en pacientes con y sin IN. Mediante regresión lineal múltiple, se estimaron los factores asociados al incremento del coste total. Resultados: se estudiaron 443 pacientes, la incidencia de IN fue 11,3%. La diferencia de las medianas en el coste total fue de 30.791,4€ por paciente entre los grupos con y sin IN. El coste mediano de la estancia de pacientes con IN fue casi ocho veces mayor que el coste mediano de los pacientes sin IN. En pacientes con IN, el coste asociado a procedimientos más elevado fue el de antibióticos, nutrición enteral y parenteral y pruebas de imagen. En el modelo multivariante los factores asociados con un mayor coste fueron: presencia de infección nosocomial, cirugía cardiovascular, tipo ingreso urgente, mayor índice pronóstico de mortalidad al ingreso y la presencia de inmunosupresión. Por el contrario, los de mayor edad y aquellos ingresados por cirugía presentaron un menor coste. Conclusiones: La IN está asociada al incremento del coste total, lo que implica que la prevención de estas infecciones mediante intervenciones específicas podría resultar costo-efectiva, redundando en sistemas de salud más seguros (AU)

Hospital costs associated with nosocomial infections in a pediatric intensive care unit.

OBJECTIVE: To estimate the additional cost attributable to nosocomial infection (NI) in a pediatric intensive care unit (PICU) and related factors. METHODS: A prospective cohort study was conducted in all children admitted to the PICU of a tertiary-care pediatric hospital between 2008 and 2009. Descriptive and bivariate analyses were conducted of total direct costs due to PICU stay and medical procedures in patients with and without NI. A log-linear regression model was performed to determine the factors associated with higher total cost. RESULTS: A total of 443 patients were studied and the prevalence of NI was 11.3%. The difference in the median total cost was €30,791.4 per patient between groups with and without NI. The median cost of PICU length of stay in patients with NI was almost eight times higher than the median cost of patients without NI. In patients with NI, the highest costs related to medical procedures were associated with antibiotics, enteral and parenteral feeding, and imaging tests. In the multivariate model, the factors associated with higher cost were infection, the performance of cardiovascular surgery, urgent admission, a higher pediatric risk mortality score, and the presence of immunosuppression. By contrast, older children and those with surgical admission generated lower cost. CONCLUSIONS: NI was associated with an increase in total cost, which implies that the prevention of these infections through specific interventions could be cost-effective and would help to increase the safety of healthcare systems.

Generic and disease-specific quality of life as a predictor of long-term mortality in heart failure.

AIMS: Although the vital prognosis of heart failure (HF) is generally poor, it varies substantially between patients. This study examined whether health-related quality of life (HRQoL) predicts long-term mortality in HF. It also evaluated the role of generic and disease-specific HRQoL questionnaires. METHODS AND RESULTS: We studied 416 patients admitted for HF-related emergencies to four hospitals in Spain in 2000-2001. Health-related quality of life was measured at study baseline with a generic questionnaire, the SF-36, and with a disease-specific one, the Minnesota Living with Heart Failure (MLWHF) questionnaire. Patients were followed prospectively to 2007 to ascertain all-cause mortality. During follow-up, 290 (69.7%) patients died. After adjustment for biomedical, healthcare, and social variables, a poor mental component summary (MCS) score on the SF-36 was associated with higher mortality [hazard ratio (HR) 1.38; 95% confidence interval (CI) 1.06-1.76]. For MLWHF, a poor physical component summary (PCS) score predicted higher mortality (HR 1.31; 95% CI 1.01-1.70). In a stepwise Cox model that included the PCS scores of both the SF-36 and the MLWHF, only the PCS of the MLWHF was retained with P<0.05. However, when both MCS scores were included, only the MCS of the SF-36 was retained with P<0.05. CONCLUSION: The SF-36 MCS and the MLWHF PCS predict long-term mortality in patients with HF. Future research should identify the determinants of HRQoL and refine interventions to improve it.

Mechanisms of the association between depressive symptoms and long-term mortality in heart failure.

BACKGROUND: The long-term prognostic influence of depression on patients hospitalized for heart failure (HF) is unknown. No previous study has examined systematically the mechanisms of the relationship between depression and mortality in HF. METHODS: Prospective study of 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals. Baseline depressive symptoms were assessed with the 10-item Geriatric Depression Scale (GDS). The association between depressive symptoms and mortality was summarized with hazard ratios (HRs) obtained from Cox regression, with sequential adjustment for possible mechanisms of the association. RESULTS: Of the 433 study participants, 103 (23.8%) had major depression (GDS-10 > or =5) at baseline. During a mean follow-up of 5.7 years, 305 deaths (70%) occurred. Compared with those who were not depressed, subjects with major depression showed higher mortality (age and sex-adjusted HR 1.52, 95% CI 1.15-2.01). Subsequent adjustment for comorbidity reduced the HR to 1.45 (95% CI 1.10-1.93). Additional adjustment for severity of cardiac lesion and for lifestyles, foremost physical inactivity, led to a HR of 1.27 (95% CI 0.95-1.70). After further adjustment for pharmacologic treatment of HF and particularly for disability in instrumental activities of daily living, the HR dropped almost to the null value (HR 1.10, 95% CI 0.82-1.49). CONCLUSIONS: Depressive symptoms in patients hospitalized for HF are associated with higher long-term mortality; this association is largely explained by the frequent comorbidity, physical inactivity, and disability of these patients.

Low-fat dairy products and blood pressure: follow-up of 2290 older persons at high cardiovascular risk participating in the PREDIMED study.

High blood pressure (BP) has been ranked as the most important risk factor worldwide regarding attributable deaths. Dietary habits are major determinants of BP. Among them, frequent intake of low-fat dairy products may protect against hypertension. Our aim was to assess the relationship between low-fat dairy product intake and BP levels and their changes after 12-month follow-up in a cohort of asymptomatic older persons at high cardiovascular risk recruited into a large-scale trial assessing the effects of Mediterranean diets on cardiovascular outcomes. Data from 2290 participants, including 1845 with hypertension, were available for analyses. Dairy products were not a specific part of the intervention; thus, data were analysed as an observational cohort. Dietary information was collected with validated semi-quantitative FFQ and trained personnel measured BP. To assess BP changes, we undertook cross-sectional analyses at baseline and at the end of follow-up and longitudinal analyses. A statistically significant inverse association between low-fat dairy product intake and systolic BP was observed for the 12-month longitudinal analysis. In the longitudinal analysis, the adjusted systolic and diastolic BP were significantly lower in the highest quintile of low-fat dairy product intake (-4.2 (95% CI -6.9, -1.4) and -1.8 (95% CI -3.2, -0.4) mmHg respectively), whereas the point estimates for the difference in diastolic BP indicated a modest non-significant inverse association. Intake of low-fat dairy products was inversely associated with BP in an older population at high cardiovascular risk, suggesting a possible protective effect against hypertension.

A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study.

OBJECTIVE: To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet. DESIGN: A 12-month assessment of a randomized primary prevention trial. SUBJECTS/SETTINGS: One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or > or =3 cardiovascular risk factors. INTERVENTION: Participants were randomly assigned to a control group or two Mediterranean diet groups. Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals, and group educational sessions on a quarterly basis. One Mediterranean diet group received free virgin olive oil (1 L/week), the other received free mixed nuts (30 g/day). Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines. MAIN OUTCOME MEASURES: Changes in food and nutrient intake after 12 months. STATISTICAL ANALYSES: Paired t tests (for within-group changes) and analysis of variance (for between-group changes) were conducted. RESULTS: Participants allocated to both Mediterranean diets increased their intake of virgin olive oil, nuts, vegetables, legumes, and fruits (P<0.05 for all within- and between-group differences). Participants in all three groups decreased their intake of meat and pastries, cakes, and sweets (P<0.05 for all). Fiber, monounsaturated fatty acid, and polyunsaturated fatty acid intake increased in the Mediterranean diet groups (P<0.005 for all). Favorable, although nonsignificant, changes in intake of other nutrients occurred only in the Mediterranean diet groups. CONCLUSIONS: A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual's overall food pattern. The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial.

[Prevalence of depression and associated medical and psychosocial factors in elderly hospitalized patients with heart failure in Spain]. / Prevalencia de depresión, y factores biomédicos y psicosociales asociados, en ancianos hospitalizados con insuficiencia cardiaca en España.

INTRODUCTION AND OBJECTIVES: This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. METHODS: The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. RESULTS: In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for > or =3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). CONCLUSIONS: Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.

Prevalencia de depresión, y factores biomédicos y psicosociales asociados, en ancianos hospitalizados con insuficiencia cardiaca en España / Prevalence of Depression and Associated Medical and Psychosocial Factors in Elderly Hospitalized Patients With Heart Failure in Spain

Introducción y objetivos. En este trabajo se estima la prevalencia de depresión y se identifican los factores biomédicos y psicosociales asociados en ancianos hospitalizados con insuficiencia cardiaca en España. Métodos. Se estudió a 433 pacientes ≥ 65 años ingresados de urgencia en 4 hospitales españoles desde enero de 2000 hasta junio de 2001, con diagnóstico principal o secundario de insuficiencia cardiaca. Se consideró que había depresión ante la presencia de 3 síntomas en la Escala de Depresión Geriátrica de 10 ítems. Resultados. Del total de pacientes estudiados, 210 (48,5%) presentaron depresión. Las cifras correspondientes fueron 71 (37,6%) en varones y 139 (57,0%) en mujeres. La depresión fue más frecuente en los pacientes con las siguientes características: grado funcional III-IV de la NYHA (odds ratio ajustada [ORa] = 2,00; intervalo de confianza [IC] del 95%, 1,23-3,24); peor puntuación en los aspectos físicos de la calidad vida (ORa = 3,14; IC del 95%,1,98-4,99); dependencia en 1 o 2 actividades básicas de la vida diaria (ABVD) (ORa = 2,52; IC del 95%, 1,41-4,51); dependencia en 3 o más ABVD (ORa = 2,47; IC del 95%, 1,20-5,07); limitación en alguna actividad instrumental de la vida diaria (ORa = 2,20; IC del 95%, 1,28- 3,79); hospitalización previa por insuficiencia cardiaca (ORa = 1,71; IC del 95%, 1,93-5,45); estaban solos en casa más de 2 h al día (ORa = 3,24; IC del 95%, 1,93- 5,45); menor satisfacción con el médico de atención primaria (ORa = 1,90; IC del 95%, 1,14-3,17). Conclusiones. La depresión es muy frecuente en los ancianos hospitalizados con insuficiencia cardiaca, y se asocia con varios factores biomédicos y psicosociales. Esta elevada frecuencia, el peor pronóstico de la insuficiencia cardiaca en presencia de síntomas depresivos y la existencia de instrumentos diagnósticos sencillos y un tratamiento eficaz apoyan el cribado sistemático de la depresión en estos pacientes (AU)

Introduction and objectives. This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. Methods. The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. Results. In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for ≥3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). Conclusions. Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients (AU)