Health-related quality of life and mortality in the 'Seguimiento Universidad de Navarra' prospective cohort study.

OBJECTIVE: To study the association between health-related quality of life (HRQoL) and all-cause mortality in a healthy middle-aged Mediterranean cohort. METHODS: We included 15,390 participants -mean age 42.8 years at first HRQoL ascertainment, all university graduates-. HRQoL was assessed with the self-administered Medical Outcomes Study Short Form-36 (SF-36) twice, with a 4-year gap. We used multivariable-adjusted Cox regression models to address the relation between self-reported health and Physical or Mental Component Summary (PCS-36 or MCS-36) and mortality, and their interaction with prior comorbidities or adherence to the Mediterranean diet (MedDiet). RESULTS: Over 8.7 years of median follow-up time, 266 deaths were identified. Hazard ratio (HR) for the excellent vs. poor/fair category in self-reported health was 0.30 (95 % confidence interval (CI), 0.16-0.57) in the model with repeated measurements of HRQoL. Both the PCS-36 (HRquartile4(Q4)vs.Q1 0.57 [95%CI, 0.36-0.90], ptrend < 0.001; HRper+10points: 0.64 [95%CI, 0.54-0.75]) and the MCS-36 (HRQ4vs.Q1 0.67 [95%CI, 0.46-0.97], ptrend = 0.025; HRper+10points: 0.86 [95%CI, 0.74-0.99]) were inversely associated with mortality in the model with repeated measurements of HRQoL. Previous comorbidities or adherence to the MedDiet did not modify these associations. CONCLUSIONS: Self-reported HRQoL -assessed as self-reported health, PCS-36 and MCS-36- obtained with the Spanish version of the SF-36 were inversely associated with mortality risk, regardless of the presence of previous comorbidities or adherence to the MedDiet.

Social mobility and healthy behaviours from a gender perspective in the Spanish multicase-control study (MCC-Spain).

There is evidence for the influence of socioeconomic status (SES) on healthy behaviours but the effect of social mobility (SM) is not yet well known. This study aims to analyse the influence of origin and destination SES (O-SES and D-SES) and SM on healthy behaviours and co-occurrence, from an integrated gender and age perspective. Data were obtained from the controls of MCC-Spain between 2008-2013 (3,606 participants). Healthy behaviours considered: healthy diet, moderate alcohol consumption, non-smoking and physical activity. SM was categorized as stable high, upward, stable medium, downward or stable low. Binary and multinomial logistic regression models were adjusted. Those aged <65, with a low O-SES, D-SES and stable low SM are less likely to have healthy behaviours in the case of both women (physically active: OR = 0.65 CI = 0.45-0.94, OR = 0.71 CI = 0.52-0.98, OR = 0.61 CI = 0.41-0.91) and men (non-smokers: OR = 0.44 CI = 0.26-0.76, OR = 0.54 CI = 0.35-0.83, OR = 0.41 CI 0.24-0.72; physically active: OR = 0.57 CI = 0.35-0.92, OR = 0.64 CI = 0.44-0.95, OR = 0.53 CI = 0.23-0.87). However, for those aged ≥65, this probability is higher in women with a low O-SES and D-SES (non-smoker: OR = 8.09 CI = 4.18-15.67, OR = 4.14 CI = 2.28-7.52; moderate alcohol consumption: OR = 3.00 CI = 1.45-6.24, OR = 2.83 CI = 1.49-5.37) and in men with a stable low SM (physically active: OR = 1.52 CI = 1.02-1.26). In the case of men, the same behaviour pattern is observed in those with a low O-SES as those with upward mobility, with a higher probability of co-occurring behaviours (three-to-four behaviours: OR = 2.00 CI = 1.22-3.29; OR = 3.13 CI = 1.31-7.48). The relationship of O-SES, D-SES and SM with healthy behaviours is complex and differs according to age and gender.

Infección por SARS-CoV-2 en el embarazo y posibilidad de transmisión al neonato: una revisión sistemática / Infection by SARS-CoV-2 in pregnancy and possibility of transmission to neonates: a systematic revision

En este trabajo se revisan los artículos publicados sobre COVID-19, embarazo y afectación del neonato hasta el 30 de abril de 2020. Se han encontrado un total de 33 publicaciones que se refieren a 553 gestantes y 456 partos. Los síntomas más frecuentes en la embarazada fueron fiebre, tos y disnea. Cerca de tercios de los partos se realizaron por cesárea; el 5,9% de las mujeres requirieron ingreso en la UCI y el 4% requirieron ventilación mecánica. No se produjo ninguna muerte materna. Hubo prematuridad en el 22,3% de los partos y el neonato requirió ingreso en la UCI en el 38,3%. Solo se informó de una muerte neonatal (0,4%) y de 13 casos de COVID-19 neonatal (3,4%). La información disponible no permite asegurar que la transmisión se produjera por vía transplacentaria

Studies published on COVID-19, pregnancy and neonate disease until 30 April 2020 are revised. We found 33 articles including 553 pregnant women and 456 deliveries. The more frequent symptoms in the pregnant women were fever, cough and dyspnoea. About two thirds deliveries were carried out via Caesarean rate; 5.9% women were admitted in the ICU and 4% required mechanic ventilation. No maternal death was reported. Prematurity occurred in 22.3% deliveries and 38.3% neonates required admission in the ICU. Only one neonatal death was reported (0.4%) and 13 neonates (3.4%) suffered COVID-19. The available information does not allow to state whether transmission to neonates occurred transplacentarily

[Infection by SARS-CoV-2 in pregnancy and possibility of transmission to neonates: A systematic revision]. / Infección por SARS-CoV-2 en el embarazo y posibilidad de transmisión al neonato: una revisión sistemática.

Studies published on COVID-19, pregnancy and neonate disease until 30 April 2020 are revised. We found 33 articles including 553 pregnant women and 456 deliveries. The more frequent symptoms in the pregnant women were fever, cough and dyspnoea. About two thirds deliveries were carried out via Caesarean rate; 5.9% women were admitted in the ICU and 4% required mechanic ventilation. No maternal death was reported. Prematurity occurred in 22.3% deliveries and 38.3% neonates required admission in the ICU. Only one neonatal death was reported (0.4%) and 13 neonates (3.4%) suffered COVID-19. The available information does not allow to state whether transmission to neonates occurred transplacentarily.

Compositional analysis of dietary patterns.

Instead of looking at individual nutrients or foods, dietary pattern analysis has emerged as a promising approach to examine the relationship between diet and health outcomes. Despite dietary patterns being compositional (i.e. usually a higher intake of some foods implies that less of other foods are being consumed), compositional data analysis has not yet been applied in this setting. We describe three compositional data analysis approaches (compositional principal component analysis, balances and principal balances) that enable the extraction of dietary patterns by using control subjects from the Spanish multicase-control (MCC-Spain) study. In particular, principal balances overcome the limitations of purely data-driven or investigator-driven methods and present dietary patterns as trade-offs between eating more of some foods and less of others.

Epidemiología del traumatismo craneoencefálico en la población mayor de 65 años a lo largo de 25 años / Epidemiology of traumatic brain injury in the elderly over a 25 year period

Objetivo: Conocer los cambios en la epidemiología del traumatismo craneoencefálico (TCE) en una cohorte de enfermos mayores de 65 años ingresados en UCI de un hospital de tercer nivel a lo largo de 25 años. Material y métodos: Estudio de cohortes retrospectivo realizado en una unidad de cuidados intensivos de un hospital universitario de tercer nivel español. Se recogieron variables demográficas, clínicas en el momento del ingreso, comorbilidades, mecanismos de lesión y lesiones presentadas, días de estancia en UCI y hospitalaria de los pacientes mayores de 65 años que ingresaron con el diagnóstico de TCE. Se realizó un análisis estadístico por lustros. Resultados: Se analizaron un total de 446 TCE en mayores de 65 años. En el análisis por lustros, se observó un aumento de la proporción de enfermos que presentan hematoma epidural (1,39% en el periodo 1990-1995 vs. 9,46% en 2010-2015), con tendencia lineal significativa (p=0,018). En la actualidad las caídas desde la propia altura han pasado de representar un 8,33% (1991-1995) a más de un 70% (2011-2015), p<0,001. El porcentaje de accidentes de tráfico ha descendido desde un 26,39% hasta un 3,95% en el último periodo, p<0,001. Conclusiones: En los últimos 25 años parece evidenciarse un cambio en la etiología del TCE en la población mayor de 65 años en nuestro ámbito

Objective: To identify the changes in the epidemiology of traumatic brain injury (TBI) in a cohort of patients older than 65 years old admitted in the Intensive care unit of a third-level hospital over a 25 year period. Material and methods: A retrospective cohort study conducted on patients over 65 years-old admitted with the diagnosis of TBI into an intensive care unit of a Spanish university hospital. The demographic, clinical variables were collected at the time of admission, including comorbidities, injury mechanisms, and injuries presented, and days of stay in ICU. A statistical analysis was carried out by five-year periods. Results: A total of 446 TBI in patients over 65 years were included. In the analysis, an increase was observed in the proportion of patients presenting with epidural haematoma (1.39% in the period 1990-1995 vs. 9.46% in 2010-2015), with a significant linear tendency (P=.018). Falls from own height have increased from 8.33% (1991-1995) to currently more than 70% (2011-2015), P<.001. The percentage of traffic accidents declined from 26.39% to 3.95% in the last period, P<.001. Conclusions: In the last 25 years there seems to be evidence of a change in the origins of TBI in the elderly in our field

Epidemiology of traumatic brain injury in the elderly over a 25 year period. / Epidemiología del traumatismo craneoencefálico en la población mayor de 65 años a lo largo de 25 años.

OBJECTIVE: To identify the changes in the epidemiology of traumatic brain injury (TBI) in a cohort of patients older than 65 years old admitted in the Intensive care unit of a third-level hospital over a 25 year period. MATERIAL AND METHODS: A retrospective cohort study conducted on patients over 65 years-old admitted with the diagnosis of TBI into an intensive care unit of a Spanish university hospital. The demographic, clinical variables were collected at the time of admission, including comorbidities, injury mechanisms, and injuries presented, and days of stay in ICU. A statistical analysis was carried out by five-year periods. RESULTS: A total of 446 TBI in patients over 65 years were included. In the analysis, an increase was observed in the proportion of patients presenting with epidural haematoma (1.39% in the period 1990-1995 vs. 9.46% in 2010-2015), with a significant linear tendency (P=.018). Falls from own height have increased from 8.33% (1991-1995) to currently more than 70% (2011-2015), P<.001. The percentage of traffic accidents declined from 26.39% to 3.95% in the last period, P<.001. CONCLUSIONS: In the last 25 years there seems to be evidence of a change in the origins of TBI in the elderly in our field.

Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II / Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II

Objetivo. Analizar la asociación entre el balance hídrico durante las primeras 24h de ingreso en UCI y las variables relacionadas con los valores de cloro (carga de cloro, tipo de fluido administrado, hipercloremia), con el empleo de técnicas de reemplazo renal secundarias a insuficiencia renal aguda (IRA-TRR) durante el posterior ingreso en UCI de los enfermos. Pacientes y métodos. Estudio multicéntrico de casos y controles, de base hospitalaria y ámbito nacional, llevado a cabo en 6 UCI. Los casos fueron pacientes mayores de 18 años que desarrollaron una IRA-TRR. Los controles fueron pacientes mayores de 18 años, ingresados en el mismo periodo y centro que los casos, que no desarrollaron IRA-TRR durante su ingreso en UCI. Se realizó emparejamiento por APACHE-II. Se llevó a cabo un análisis de regresión logística no condicional ajustada por edad, sexo, APACHE-II. Las variables de interés principales fueron: balance hídrico, carga de cloro administrada, e IRA-TRR. Resultados. Se han analizado las variables de 310 enfermos. Se evidenció un aumento del 10% en la posibilidad de desarrollar IRA-TRR por cada 500ml de balance hídrico positivo (OR: 1,09 [IC 95%:1,05-1,14]; p<0,001). El estudio de los valores medios de carga administrada no evidenció diferencias entre el grupo de casos y de controles (299,35±254,91 frente a 301,67±234,63; p=0,92). Conclusiones. El balance hídrico en las primeras 24h de ingreso en UCI se relaciona con el desarrollo de IRA-TRR, independientemente de la cloremia (AU)

Objective. To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients’ admission to ICU. Patients and methods. Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). Results. We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). Conclusions. The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia (AU)

Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II. / Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II.

OBJECTIVE: To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients' admission to ICU. PATIENTS AND METHODS: Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). RESULTS: We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). CONCLUSIONS: The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia.

Anti-TNF-α therapy reduces retinol-binding protein 4 serum levels in non-diabetic patients with psoriasis: a 6-month prospective study.

BACKGROUND: Retinol-binding protein-4 (RBP4), an adipokine considered as an emerging cardiometabolic risk factor, is increased in patients with moderate-to-severe psoriasis. OBJECTIVE: In this study, we aimed to establish the effect of anti-TNF-α therapy on RBP4 levels in patients with moderate-to-severe psoriasis. We also assessed if RBP4 levels correlate with metabolic syndrome features and disease severity in these patients. METHODS: Prospective study on a series of consecutive non-diabetic patients with moderate-to-severe psoriasis who completed 6 months of therapy with adalimumab. Patients with kidney disease, hypertension or body mass index ≥ 35 kg/m(2) were excluded. Metabolic and clinical evaluation was performed at the onset of treatment (time 0) and at month 6. RESULTS: Twenty-nine patients were assessed. Statistically significant reduction (P = 0.0001) of RBP4 levels was observed after 6 months of therapy (RBP4 at time 0: 55.7 ± 21.4 µg/mL, vs. 35.6 ± 29.9 µg/mL at month 6). No significant correlation between basal RBP4 levels and metabolic syndrome features or disease severity was found. Nevertheless, although RBP4 levels did not correlate with insulin resistance, a negative and significant correlation between RBP4 levels obtained after 6 months of adalimumab therapy and other metabolic syndrome features such as abdominal perimeter and body mass index were observed. At that time, a negative and significant correlation between RBP4 levels and disease activity scores and ultrasensitive CRP levels was also disclosed. CONCLUSION: Our results support an influence of the anti-TNF-α blockade on RBP4 serum levels. This finding is of potential relevance due to increased risk of cardiovascular disease in patients with psoriasis.

Relationship of leptin with adiposity and inflammation and resistin with disease severity in psoriatic patients undergoing anti-TNF-alpha therapy.

BACKGROUND: Altered secretion patterns of proinflammatory adipokines may influence the increased risk of cardiovascular mortality observed in patients with chronic inflammatory diseases. OBJECTIVE: To determine whether two adipokines, leptin and resistin, correlate with metabolic syndrome features and disease severity in psoriatic patients who underwent anti-TNF-α therapy. METHODS: Prospective study of consecutive non-diabetic patients with moderate-to-severe psoriasis who completed 6 months of therapy with anti-TNF-α- adalimumab. Patients with kidney disease, hypertension or body mass index ≥35 Kg/m(2) were excluded. Metabolic and clinical evaluation was performed at the onset of anti-TNF-α treatment and at month 6. RESULTS: Twenty-nine patients were assessed. A correlation between adiposity and leptin was observed (waist circumference and leptin levels after 6 months of therapy: r = 0.43; P = 0.030). Leptin concentration also correlated with blood pressure before adalimumab onset (systolic: r = 0.48; P = 0.013 and diastolic blood pressure: r = 0.50; P = 0.010 ). A marginally significant negative correlation between insulin sensitivity (QUICKI) and leptin levels was also observed. CRP levels correlated with leptin prior to the onset of adalimumab (r = 0.45; P = 0.020) and with resistin both before (r = 0.45; P = 0.020) and after 6 months of therapy (r = 0.55; P = 0.004). A positive association between parameters of disease activity such as BSA (r = 0.60; P = 0.001) and PASI (r = 0.63; P = 0.001) prior to the onset of adalimumab therapy and resistin concentrations was also disclosed. No significant changes in leptin and resistin concentrations following the 6-month treatment with adalimumab were seen. CONCLUSION: In patients with moderate-to-severe psoriasis leptin correlates with metabolic syndrome features and inflammation whereas resistin correlate with inflammation and disease severity.

Effect of cold temperatures on mortality in Cantabria (Northern Spain): a case-crossover study.

OBJECTIVES: To determine the impact of low temperatures on mortality in a Spanish region that includes both rural and urban areas. STUDY DESIGN: Case-crossover study. METHODS: A case-crossover study was conducted on the impact of cold temperatures on mortality in Cantabria, a Spanish region which includes both rural and urban areas, in 2004-2005. Odds ratios for several cold weather indicators were estimated using conditional logistic regression, adjusting for humidity and wind speed. Zero- to 6-day lags in the temperature effect were considered. RESULTS: Temperatures lower than the 5th percentile were strongly associated with mortality compared with temperatures above the 5th percentile (OR 3.40, 95% confidence interval 2.95-3.93 for 6-day lag). All temperature indices show a negative association with mortality; for instance, the maximum temperature had ORs of 0.71, 0.58, 0.32 and 0.16 for Quintiles 2-5 (reference: Quintile 1). This effect was common to all age groups. CONCLUSION: Cold weather is strongly associated with mortality in small cities and rural areas.

Topiramato en el tratamiento de la dependencia etílica: un metaanálisis / Topiramate in the treatment of alcohol dependence: a meta-analysis

Introducción. Algunos ensayos clínicos controlados han estudiado la eficacia del topiramato para el tratamiento del alcoholismo. En este artículo, primero realizamos un meta análisis de los ensayos donde el topiramato era comparado con el placebo, y después revisamos la eficacia en los ensayos donde era comparado con otros fármacos. Método. Una síntesis cuantitativa de los datos se llevó acabo ponderando por el inverso de la varianza en un modelo de efectos aleatorios. Resultados. En base a tres ensayos clínicos controlados, el topiramato es más eficaz que el placebo en: reducción del porcentaje de los días de consumo elevado (23,2%, intervalo de confianza [IC] del 95%: 15,7 a 34,4), incremento del número de días de abstinencia (diferencia media: 2,9 días, IC del 95%: 2,5 a 3,3) y descenso del logaritmo de los niveles de epsilon-GT (diferencia media: 0,075, IC del 95%: 0,048 a 0,118).Dos ensayos sugirieron que el topiramato es también más eficaz que la naltrexona y un estudio abierto refirió mejores resultados para el disulfirán que para el topiramato. Conclusiones. El topiramato puede ser utilizado para el tratamiento en la dependencia etílica; los efectos adversos tales como las parestesias o el insomnio deben ser tenidos en cuenta cuando se prescribe topiramato. La dosis óptima precisa investigación adicional (AU)

Introduction. Several controlled clinical trials have studied the efficacy of topiramate in the treatment of alcohol dependence: a metaanalysis Introduction. Several controlled clinical trials have studied the efficacy of topiramate in the treatment of alcoholism. In this paper, we have performed a metaanalysis of those trials in which topiramate was compared with placebo and then we reviewed its efficacy in trials in which it was compared with other drugs. Method. A quantitative synthesis of data was performed using inverse variance weighting in a random effects model. Results. Based on three placebo-controlled trials, topiramate is more efficacious than placebo in reducing the percentage of heavy drinking days (23.2%, 95% confidence interval [CI]: 15.7 to 34.4), increasing the number of days of abstinence (mean difference: 2.9 days, 95%CI: 2.5 to 3.3), and lowering the logarithm of g-GT levels(mean difference: 0.075 95% CI: 0.048 to 0.118). Two trials suggested that topiramate is also more efficacious than naltrexone, and one open-label study reported better results for disulfiram than for topiramate. Conclusion. Topiramate can be used in alcohol dependence. Adverse effects such as paresthesia or insomnia should be taken into account when prescribing topiramate. Its optimal dosage requires further research (AU)

Factores que determinan la alta satisfacción del usuario con la asistencia hospitalaria / Factors associated with patient satisfaction with hospital care

Objetivo. Identificar la influencia sobre la alta satisfacciónde factores sociodemográficos, asistenciales y decomunicación.Material y Métodos. Estudio de corte transversal medianteencuesta telefónica a pacientes dados de alta duranteel mes de septiembre de 2006. Instrumento de medida:cuestionario SERQVHOS. Como medida de fuerza de asociaciónse ha utilizado la odds ratio (OR) y su intervalode confianza (IC) al 95%. Para el ajuste por factores deconfusión se ha utilizado el análisis de regresión logística.Resultados. La tasa de respuesta fue del 80,9%. Al evaluarla influencia de características sociodemográficas, se observaque los usuarios con nacionalidad no pertenecientea la Unión Europea mostraron mayor satisfacción que losespañoles (OR=3,01 IC 95%: 1,40-3,51), y los entrevistadoscon estudios primarios resultaron más satisfechos que losuniversitarios (OR=2,85 IC 95% [1,88-4,35]). En cuanto afactores asistenciales, en los pacientes con reingresos porla misma categoría diagnóstica mayor se observó una menorprevalencia de alta satisfacción, con una OR de 0,67 ysignificación limítrofe. Por último, respecto a la comunicación,los tres aspectos más asociados a la alta satisfacciónfueron la identificación correcta del personal (OR: 6,22 IC95% [3,52-10,97]), recibir información suficiente sobre elestado de salud (OR: 3,83 IC 95% [1,94-7,57]) y recibir informaciónsobre el lugar y horario de información médica(OR: 2,60 IC95% [1,60-4,22]).Conclusiones. La comunicación incide favorablementeen la percepción final de la asistencia lo que justificaque se continúe trabajando en su mejora en los centrossanitarios de nuestra comunidad(AU)

Objective. To identify the influence of sociodemographic,care and communication factors on patient satisfaction.Methods. Cross-sectional study by means of a telephonicsurvey of patients discharged during September,2006. Instrument for measuring satisfaction: SERQVHOSquestionnaire. Statistical analysis: we used odds ratio(OR) and its 95% confidence interval (CI); adjustmentfor confusion factors was performed using multiple logisticregression.Results. Response rate was 80.9%. On evaluating the influenceof sociodemographic characteristics, we observedthat patients whose nationality did not correspondto the European Union were more satisfied than Spanishpatients (OR=3.01; 95% CI: 1.40-3.51); subjects who hadonly completed primary studies were more satisfiedthan those with university studies (OR = 2.85, 95% CI:1.88-4.35). With respect to care factors, patients readmittedbecause of the same major diagnostic category hadlower satisfaction (OR=0.67, bordering statistical significance).Finally, with regard to communication factors,the three aspects most associated with patient satisfactionwere: correct health-care personnel identification(OR: 6.22 95% CI: 3.52-10.97), receiving enough informationabout his/her state of health (OR: 3.83 95% CI: 1.94-7.57), and being informed about the place and schedulefor medical information (OR: 2.60, 95% CI: 1.60-4.22).Conclusions. Communication favourably affects thefinal perception of care, which justifies the continuityof its improvement in the health centres of our region(AU)

[Factors associated with patient satisfaction with hospital care]. / Factores que determinan la alta satisfacción del usuario con la asistencia hospitalaria.

OBJECTIVE: To identify the influence of sociodemographic, care and communication factors on patient satisfaction. METHODS: Cross-sectional study by means of a telephonic survey of patients discharged during September, 2006. Instrument for measuring satisfaction: SERQVHOS questionnaire. STATISTICAL ANALYSIS: we used odds ratio (OR) and its 95% confidence interval (CI); adjustment for confusion factors was performed using multiple logistic regression. RESULTS: Response rate was 80.9%. On evaluating the influence of sociodemographic characteristics, we observed that patients whose nationality did not correspond to the European Union were more satisfied than Spanish patients (OR=3.01; 95% CI: 1.40-3.51); subjects who had only completed primary studies were more satisfied than those with university studies (OR = 2.85, 95% CI: 1.88-4.35). With respect to care factors, patients readmitted because of the same major diagnostic category had lower satisfaction (OR=0.67, bordering statistical significance). Finally, with regard to communication factors, the three aspects most associated with patient satisfaction were: correct health-care personnel identification (OR: 6.22 95% CI: 3.52-10.97), receiving enough information about his/her state of health (OR: 3.83 95% CI: 1.94-7.57), and being informed about the place and schedule for medical information (OR: 2.60, 95% CI: 1.60-4.22). CONCLUSIONS: Communication favourably affects the final perception of care, which justifies the continuity of its improvement in the health centres of our region.

Lavado de manos: experiencias de dos comunidades autónomas / Hand hygiene: Experience in two Spanish Autonomous Regions

Fundamento y Objetivo: El Ministerio de Sanidad y Consumo, alineado con las directrices marcadas desde la Organización Mundial de la salud (OMS) en la promoción de la práctica de manos limpias en los centros sanitarios, persigue reforzar la adhesión al lavado de manos entre sus profesionales. En este estudio se presentan los resultados de las actuaciones implementadas en dos comunidades autónomas destinadas a incrementar la adhesión de la higiene de manos entre los profesionales sanitarios a través de un programa multimodal de mejora. Material y Método: Lugar: servicios de salud de la Comunidad Autónoma de Cantabria y la Región de Murcia. El proyecto se plantea en 3 fases: fase I: análisis de situación preimplantación a través de un estudio observacional analítico en unidades asistenciales abiertas, y un estudio transversal de percepción de la adhesión mediante encuesta autocumplimentada; fase II: implantación del plan formativo y fomento del empleo de soluciones hidroalcohólicas; fase III: reevaluación de los resultados alcanzados a través de un estudio observacional analítico postintervención. Resultados: Se observa un incremento significativo de la frecuencia de adhesión al lavado de manos en ambas comunidades autónomas: 40,5%; intervalo de confianza (IC) del 95%, 38,2-42,4 frente al 46,2%, IC del 95%, 44,0-48,4 (p < 0,001) en Cantabria y de un 43 frente a un 54% en Murcia (p < 0,001). Conclusiones: Se necesita seguir insistiendo en la necesidad de cumplir las recomendaciones y desarrollar nuevas intervenciones que aumenten el cumplimiento por parte del personal sanitario, así como promover políticas educativas y facilitar el acceso a las soluciones hidroalcohólicas (AU)

Background and Objective: The Spanish Ministry of Health in accordance with WHO guidelines, promotes hand washing in hospitals, with the objective of reinforcing the commitment of health care workers to hand washing. In this study we described the results of the actions implemented in two communities, which were aimed at increasing hand-washing compliance among health care workers by means of a multimodal improvement programme. Material and Method: Setting: Cantabrian and Murcian health services. The project was carried out in three phases Phase I: analysis of preimplantation situation by means of an observational study in open care units, and a cross study of self-perceived compliance to hand hygiene with a questionnaire. Phase II: Implementing of training plan and promoting the use of alcohol-based solutions. Phase III: Reassessment of the results achieved by means of a post- intervention observational study. Results: There has been a significant increase in frequency of hand washing adherence in both communities. 40.5% 95%CI [38.2-42.4] vs. 46.2% 95% CI [44.0-48.4] (p < .001) in Cantabria, and 43% vs. 54% in Murcia. Conclusions: The need to implement recommendations must continue to be emphasized and new interventions developedto increase health workers compliance, as well as promote educational policies and ease of access to alcohol-based solutions (AU)

[Hand hygiene: experience in two Spanish autonomous regions]. / Lavado de manos: experiencias de dos comunidades autónomas.

BACKGROUND AND OBJECTIVE: The Spanish Ministry of Health in accordance with WHO guidelines, promotes hand washing in hospitals, with the objective of reinforcing the commitment of health care workers to hand washing. In this study we described the results of the actions implemented in two communities, which were aimed at increasing hand-washing compliance among health care workers by means of a multimodal improvement programme. SETTING: Cantabrian and Murcian health services. The project was carried out in three phases. Phase I: analysis of preimplantation situation by means of an observational study in open care units, and a cross study of self-perceived compliance to hand hygiene with a questionnaire. Phase II: Implementing of training plan and promoting the use of alcohol-based solutions. Phase III: Reassessment of the results achieved by means of a post- intervention observational study. RESULTS: There has been a significant increase in frequency of hand washing adherence in both communities. 40.5% 95% CI [38.2-42.4] vs. 46.2% 95% CI [44.0-48.4] (p < .001) in Cantabria, and 43% vs. 54% in Murcia. CONCLUSIONS: The need to implement recommendations must continue to be emphasized and new interventions developed to increase health workers compliance, as well as promote educational policies and ease of access to alcohol-based solutions.