Prevalence and Risk Factors Associated With Low Fluid Intake in Institutionalized Older Residents.

OBJECTIVE: The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors. DESIGN: This was a cross-sectional study. SETTING AND PARTICIPANTS: The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years. MEASURES: Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected. RESULTS: Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio. CONCLUSIONS/IMPLICATIONS: The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes.

[How to improve hydration and fluid intake in institutionalized older people? A scientific literature review]. / ¿Cómo mejorar la hidratación y la ingesta hídrica en las personas mayores institucionalizadas? Una revisión de la literatura científica.

BACKGROUND: residents are vulnerable to suffer of dehydration due to physiological changes and the physical and cognitive limitations. AIM: to handle this situation, it has been decided to evaluate the interventions which are carried out for the management of dehydration and low fluid intake in older people living in nursing homes. METHODS: the revised scientific literature review methodology of PRISMA was applied. An electronic database search was performed in PubMed, Scopus, CINAHL and other sources databases. The literature search was carried out between October 2016 and January 2017. Out of a total of 3,379 articles extracted, eleven studies were selected for analysis. In addition, their quality was assessed through Cochrane and the Newcastle-Ottawa Scale. RESULTS: the risk of bias in the studies was mostly medium. Regarding the results, the interventions were classified according to whether they were invasive or non-invasive. Invasive interventions were intravenous and/or subcutaneous fluid therapy. Their effectiveness was related to the clinical improvement of dehydration. However, local reactions appeared. Non-invasive interventions focused on the individualized assistance, the stimulation to drink more and the consideration of the preferences of each resident, producing an increase in fluid intake and an improvement in analytical parameters. CONCLUSIONS: given the peculiarities of the institutionalized elderly population, both types of intervention have been shown to have a positive effect on improving hydration. Nonetheless, non-invasive interventions have confirmed to be more efficient given their simplicity of application and cause fewer adverse effects.

INTRODUCCIÓN: los residentes son vulnerables a sufrir deshidratación por los cambios fisiológicos y las limitaciones físicas y cognitivas que padecen. OBJETIVO: para manejar esta situación, se ha decidido evaluar las intervenciones que se llevan a cabo para el manejo de la deshidratación y la baja ingesta hídrica en las personas mayores institucionalizadas en residencias geriátricas. MÉTODOS: se realizó una revisión de la literatura científica siguiendo la metodología PRISMA mediante búsquedas sistemáticas en las bases de datos PubMed, Scopus, CINAHL y otras fuentes. De un total de 3.379 artículos extraídos, se seleccionaron once estudios para su análisis. Además, se avaluó su calidad a través de Cochrane y la Newcastle-Ottawa Scale. RESULTADOS: el riesgo de sesgo de los estudios fue medio en su mayoría. En cuanto a los resultados, las intervenciones se clasificaron según fuesen invasivas o no invasivas. Las intervenciones invasivas fueron la sueroterapia intravenosa y/o subcutánea y su efectividad estuvo relacionada con la mejora clínica de la deshidratación. No obstante, aparecieron reacciones locales. Las no invasivas se centraron en la asistencia individualizada, la estimulación para beber más y tener en cuenta las preferencias de cada residente, produciendo un aumento de la ingesta y una mejora en los parámetros analíticos. CONCLUSIONES: dadas las peculiaridades de la población mayor institucionalizada, ambos tipos de intervención han demostrado tener un efecto positivo en la mejora de la hidratación. No obstante, las intervenciones no invasivas han confirmado ser más eficientes dada su sencillez de aplicación y provocar menos efectos Adversos.

¿Cómo mejorar la hidratación y la ingesta hídrica en las personas mayores institucionalizadas? Una revisión de la literatura científica / How to improve hydration and fluid intake in institutionalized older people? A scientific literature review

Introducción: los residentes son vulnerables a sufrir deshidratación por los cambios fisiológicos y las limitaciones físicas y cognitivas que padecen. Objetivo: para manejar esta situación, se ha decidido evaluar las intervenciones que se llevan a cabo para el manejo de la deshidratación y la baja ingesta hídrica en las personas mayores institucionalizadas en residencias geriátricas. Métodos: se realizó una revisión de la literatura científica siguiendo la metodología PRISMA mediante búsquedas sistemáticas en las bases de datos PubMed, Scopus, CINAHL y otras fuentes. De un total de 3.379 artículos extraídos, se seleccionaron once estudios para su análisis. Además, se avaluó su calidad a través de Cochrane y la Newcastle-Ottawa Scale. Resultados: el riesgo de sesgo de los estudios fue medio en su mayoría. En cuanto a los resultados, las intervenciones se clasificaron según fuesen invasivas o no invasivas. Las intervenciones invasivas fueron la sueroterapia intravenosa y/o subcutánea y su efectividad estuvo relacionada con la mejora clínica de la deshidratación. No obstante, aparecieron reacciones locales. Las no invasivas se centraron en la asistencia individualizada, la estimulación para beber más y tener en cuenta las preferencias de cada residente, produciendo un aumento de la ingesta y una mejora en los parámetros analíticos. Conclusiones: dadas las peculiaridades de la población mayor institucionalizada, ambos tipos de intervención han demostrado tener un efecto positivo en la mejora de la hidratación. No obstante, las intervenciones no invasivas han confirmado ser más eficientes dada su sencillez de aplicación y provocar menos efectos adversos

Background: residents are vulnerable to suffer of dehydration due to physiological changes and the physical and cognitive limitations. Aim: to handle this situation, it has been decided to evaluate the interventions which are carried out for the management of dehydration and low fluid intake in older people living in nursing homes. Methods: the revised scientific literature review methodology of PRISMA was applied. An electronic database search was performed in PubMed, Scopus, CINAHL and other sources databases. The literature search was carried out between October 2016 and January 2017. Out of a total of 3,379 articles extracted, eleven studies were selected for analysis. In addition, their quality was assessed through Cochrane and the Newcastle-Ottawa Scale. Results: the risk of bias in the studies was mostly medium. Regarding the results, the interventions were classified according to whether they were invasive or non-invasive. Invasive interventions were intravenous and/or subcutaneous fluid therapy. Their effectiveness was related to the clinical improvement of dehydration. However, local reactions appeared. Non-invasive interventions focused on the individualized assistance, the stimulation to drink more and the consideration of the preferences of each resident, producing an increase in fluid intake and an improvement in analytical parameters. Conclusions: given the peculiarities of the institutionalized elderly population, both types of intervention have been shown to have a positive effect on improving hydration. Nonetheless, non-invasive interventions have confirmed to be more efficient given their simplicity of application and cause fewer adverse effects

Correction: Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

[This corrects the article DOI: 10.1371/journal.pone.0194967.].

Risk factors associated with dehydration in older people living in nursing homes: Scoping review.

BACKGROUND: Dehydration in the older people is a prevalent problem that is often associated with physiological changes, physical limitations and environmental conditions. OBJECTIVES: The scoping review was carried out to identify risk factors associated with dehydration in older people living in nursing homes. DESIGN: The revised scoping methodology framework of Arksey and O'Malley (2005) was applied. Study selection was carried out in accordance with Davis et al. (2009) and focused on the inclusion criteria (people over 65 years old and living in nursing homes). Risk factors were classified using the geriatric assessment. DATA SOURCES: An electronic database search was performed in PubMed, Scopus and CINAHL. The literature search was carried out between October 2016 and January 2017. REVIEW METHODS: Thematic reporting was performed and study findings were validated through interdisciplinary meetings of experts. The quality of the papers consulted was also evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional, cohort and case-control studies. RESULTS: In all, 16 papers were analysed, all of which were observational studies. The risk of bias ranged from very low (n = 1), to medium (n = 13) and high (n = 2). The risk factors were classified in line with the different components of the geriatric assessment. In the socio-demographic characteristics age and gender were identified. In the clinical component, infections, renal and cardiovascular diseases and end-of-life situations were the most common factors highlighted in the papers analysed. With reference to the functional component, its limitation was associated with dehydration, while for factors of mental origin, it was related to dementia and behavioural disorders. Finally, the factors relating to the social component were institutionalisation, requiring a skilled level of care and it being winter. CONCLUSIONS: The most commonly repeated factors highlighted in the review were age, gender, infections, end of life and dementia, with it being important to highlight the large number of factors in the clinical component. Even so, the great majority of the factors were unmodifiable conditions associated typically associated with the physiology of ageing.

Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

BACKGROUND: Despite the number of studies that have tried to demonstrate that there is an association between previous falls and the fear of falling, the relationship between these two variables remains a matter of controversy. OBJECTIVES: Our objective was to investigate whether the fear of falling is a cause of falls, a consequence, or both in community-dwelling adults aged ≥ 75 years old. METHODS: A descriptive, longitudinal, prospective study was performed. A total of 640 individuals were interviewed between 2009 and 2011. Sociodemographic data, health status, history of falls and fear of falling were assessed at baseline and at 24 months. RESULTS: The prevalence of falls at baseline was 25% as opposed to 35.2% at 24 months. The prevalence of the fear of falling was 41.5% at baseline. Logistic regression analysis showed a significant association between a history of falls and the fear of falling. Other factors associated with the fear of falling were female gender, comorbidity, depressive symptoms, and disability. In total, 41.7% of the subjects who had reported a fear of falling at baseline had suffered at least one fall 24 months later. Unadjusted Cox regression analysis revealed that the fear of falling was a risk factor for falls. According to the final model adjusted for other covariates, the only reliable predictor was female gender. The Cox model stratified by gender failed to show a crude association between fear of falling and falls. CONCLUSION: A previous history of falls in the previous year was a good predictor of the fear of falling; but the fear of falling was a predictor of falls during follow-up only in the unadjusted model, pointing to strong gender turns out as an effect modifier of the association of FOF and subsequent falls. Nursing staff working in elderly care should not only routinely assess patients' previous history of falls, but also evaluate their fear of falling and its associated factors.

Respuesta: Malnutrición: un dominio más de la fragilidad clínica / Reply: Malnutrition: Another domain of frailty

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La fragilidad como predictora de mortalidad en una cohorte de edad avanzada / Frailty as a predictor of mortality in a cohort of people aged 75 years and older

Objetivo. Determinar la asociación entre los estados de fragilidad de las personas mayores y la mortalidad en la ciudad de Lleida durante el período 2009-2012. Método. Estudio longitudinal prospectivo realizado con sujetos que viven en la ciudad de Lleida de 75 años o más de edad con tarjeta sanitaria y residentes en viviendas familiares. La fase transversal se realizó entre los años 2009 y 2010, y la fase longitudinal a los 2 años (mediana 25 meses). Resultados. La supervivencia fue peor para los frágiles frente a los prefrágiles y los no frágiles (log rank = 10,56; p = 0,005). Además de la fragilidad (hazard ratio [HR] = 4,95; intervalo de confianza del 95% [IC95%]: 1,71-14,31), la edad también fue significativa (HR = 2,87; IC95%: 1,02-8,26). Conclusión. En una cohorte prospectiva de mayores de 75 años que viven en su propio domicilio en la ciudad de Lleida, el mayor nivel de fragilidad está asociado con un mayor riesgo de muerte a los 2 años (AU)

Objective. To determine the association between frailty in older persons and mortality in the city of Lleida (Spain) between 2009 and 2012. Methods. We conducted a prospective longitudinal study based on persons living in the city of Lleida aged 75 years and older, covered by the public health system and living in single-family households. The cross-sectional study was performed between 2009 and 2010 and longitudinal study was carried out 3 years later (median 25 months). Results. Survival was lower in frail individuals than in pre-frail and non-frail individuals (log rank = 10.56; p = 0.005). In addition to frailty (HR = 4.95; 95%CI: 1.71-14.31). Age was also a significant predictor (HR = 2.87; 95%CI: 1.02-8.26). Conclusion. A higher level of frailty was associated with an increased risk of death at 2 years in a prospective cohort of elderly persons older than 75 years living in their own homes in the city of Lleida (AU)

Asociación entre el Mini Nutritional Assessment y el índice de fragilidad de Fried en las personas mayores que viven en la comunidad / Association between Mini Nutritional Assessment and the Fried frailty index in older people living in the community

Fundamento y objetivo: Valorar la asociación entre el Mini Nutritional Assessment (MNA) y el índice de fragilidad de Fried en las personas mayores que viven en la comunidad. Material y método: Estudio transversal en individuos de 75 años o más, residentes en la comunidad. Como variables se incluyeron el estado nutricional medido a través del MNA y su forma abreviada, el Mini Nutritional Assessment Short Form (MNA-SF), y el índice de fragilidad a través de los criterios de Fried. Resultados: La muestra fue de 640 individuos, con media (DE) de edad de 81,3 (5,0) años; el 39,7% eran varones. Según el MNA-SF, el 76,9% de los individuos estaban bien nutridos, el 19,8% en riesgo de desnutrición y el 1,9% desnutridos, mientras que según el MNA, dichos porcentajes fueron del 78,1, 19,6 y 2,3%, respectivamente. Según los criterios de Fried, el 43,4% eran no frágiles, el 47%, prefrágiles, y el 9,6%, frágiles. La mayor proporción de sujetos frágiles se encontraban en riesgo de desnutrición. La puntuación del MNA y del MNA-SF en los sujetos frágiles fue significativamente menor que en los prefrágiles y no frágiles. A medida que aumentaba la puntuación de los componentes del MNA, aumentaba el índice de fragilidad. Así mismo, existía una asociación significativa entre los 5 criterios de fragilidad y las categorías del MNA y el MNA-SF. El área bajo la curva ROC para el MNA-SF fue de 0,75, mientras que para el MNA fue de 0,80. Conclusiones: Los resultados presentados ponen de manifiesto la clara asociación entre el MNA y los criterios de Fried. También evidencian que la categoría del MNA «riesgo de desnutrición» es la que está más fuertemente asociada al índice de fragilidad (AU)

Background and objective: To assess the association between Mini Nutritional Assessment (MNA) and the Fried frailty index in older people living in the community. Material and method: Cross-sectional study of individuals aged 75 and over living in the community. Variables: nutritional status measured by Mini Nutritional Assessment Short Form (MNA-SF) and MNA, and frailty measured by Fried’s frailty criteria. Results: The sample consisted of 640 individuals with a mean age of 81.3 5.0 years; 39.7% were men. According to the MNA-SF, 76.9% of patients were well nourished, 19.8% were at risk of malnutrition and 1.9% were malnourished, while percentages were 78.1, 19.6 and 2.3%, respectively, according to the MNA. According to Fried criteria, 43.4% were not frail, 47% were pre-frail and 9.6% were frail. The largest proportion of frail subjects were at risk of malnutrition. The higher the score of MNA components, the higher was the frailty index. Likewise, there was a significant association between the 5 frailty criteria and the categories of MNA and MNA-SF. The area under the ROC curve for the MNA-SF was 0.75 while for the MNA it was 0.80. Conclusions: The results presented show a clear association between Mini Nutritional Assessment and Fried’s criteria. They also suggest that the «nutritional risk» MNA category is the one most strongly associated with the Fried’s frailty index (AU)

[Frailty as a predictor of mortality in a cohort of people aged 75 years and older]. / La fragilidad como predictora de mortalidad en una cohorte de edad avanzada.

OBJECTIVE: To determine the association between frailty in older persons and mortality in the city of Lleida (Spain) between 2009 and 2012. METHODS: We conducted a prospective longitudinal study based on persons living in the city of Lleida aged 75 years and older, covered by the public health system and living in single-family households. The cross-sectional study was performed between 2009 and 2010 and longitudinal study was carried out 3 years later (median 25 months). RESULTS: Survival was lower in frail individuals than in pre-frail and non-frail individuals (log rank=10.56; p=0.005). In addition to frailty (HR=4.95; 95%CI: 1.71-14.31). Age was also a significant predictor (HR=2.87; 95%CI: 1.02-8.26). CONCLUSION: A higher level of frailty was associated with an increased risk of death at 2 years in a prospective cohort of elderly persons older than 75 years living in their own homes in the city of Lleida.

[Association between Mini Nutritional Assessment and the Fried frailty index in older people living in the community]. / Asociación entre el Mini Nutritional Assessment y el índice de fragilidad de Fried en las personas mayores que viven en la comunidad.

BACKGROUND AND OBJECTIVE: To assess the association between Mini Nutritional Assessment (MNA) and the Fried frailty index in older people living in the community. MATERIAL AND METHOD: Cross-sectional study of individuals aged 75 and over living in the community. VARIABLES: nutritional status measured by Mini Nutritional Assessment Short Form (MNA-SF) and MNA, and frailty measured by Fried's frailty criteria. RESULTS: The sample consisted of 640 individuals with a mean age of 81.3±5.0 years; 39.7% were men. According to the MNA-SF, 76.9% of patients were well nourished, 19.8% were at risk of malnutrition and 1.9% were malnourished, while percentages were 78.1, 19.6 and 2.3%, respectively, according to the MNA. According to Fried criteria, 43.4% were not frail, 47% were pre-frail and 9.6% were frail. The largest proportion of frail subjects were at risk of malnutrition. The higher the score of MNA components, the higher was the frailty index. Likewise, there was a significant association between the 5 frailty criteria and the categories of MNA and MNA-SF. The area under the ROC curve for the MNA-SF was 0.75 while for the MNA it was 0.80. CONCLUSIONS: The results presented show a clear association between Mini Nutritional Assessment and Fried's criteria. They also suggest that the "nutritional risk" MNA category is the one most strongly associated with the Fried's frailty index.

Estado de animo caracterizadopor soledad y tristeza: factores relacionados en personas mayores / Characterized mood by loneliness and sadness: factors related elderly

El objetivo de este estudio fue conocer el estado de animo y los factores que pueden influir en las personas mayores. Se trata de un estudio epidemiologico y transversal que incluye a personas mayores de 65 años de instituciones atendidos en diferentes niveles asistenciales en la ciudad de Lleida. Las variables incluida sfueron, ademas del estado de animo caracterizado por soledad y tristeza, las caracteristicas sociodemograficas y diversos parámetros del estado de salud. La depresion es una alteracion patologica del estado de animo. Es importante detectar este último ya que puede predecir la gravedad de la depresion en las personas de edad avanzada. El personal de enfermeria se encuentra en una situación privilegiada por su proximidad con los pacientes (AU)

The aim of this study was to determine the prevalence of mood and the factors that can affect older people. Cross-sectional epidemiological study including people aged ≥ 65 years of institutions with different levels of care located in the city of Lleida. The variables included, in addition to depressed mood characterized by loneliness and sadness, the sociodemographic characteristics and various health parameters. Depression is a pathological alteration of mood. It is important to detect because it can predict the severity of depression in elderly. The nursing staff is in a prime location for its proximity to patients (AU)

Brote de gastroenteritis por el consumo de agua de suministro público causado por Shigella sonnei / Waterborne outbreak of Shigella sonnei caused by consumption of public supply water

Objetivos Investigar un brote de gastroenteritis que afectó a la población de València d’ Àneu (Lleida). Métodos Estudio de cohortes sobre el consumo de agua de la red, de agua embotellada y de agua de manantiales. La cohorte se elaboró mediante contacto telefónico con todos los números privados del municipio. Se encuestó al 58,3% de la población censada (105/180) sobre diferentes consumos de agua, número de vasos consumidos diariamente y sintomatología. Se tomaron muestras de agua de la red municipal y de heces de diez enfermos. La implicación de cada agua consumida se estudió con el riesgo relativo (RR) y su intervalo de confianza del 95% (IC95%).Resultados La tasa de ataque global fue del 64,8% (68/105). La curva epidémica fue concordante con una exposición de 6 días. Resultó implicado el consumo de agua de suministro público (RR=4,2; IC95%: 1,5-11,9). Además, se constató una relación dosis-respuesta (χ2=34,1; p <0,001). Presentaron un riesgo superior de enfermar los consumidores de dos a tres vasos diarios (RR=4,3; IC95%: 1,9-9,9) y de más de tres vasos (RR=4,9; IC95%: 2,2-10,9). El clorador del agua de la red se congeló y dejó de funcionar. Seis coprocultivos resultaron positivos para Shigella sonnei. Conclusiones Brote hídrico causado por S. sonnei por contaminación del agua de la red. Se recomendó investigar el vertido ilegal de aguas residuales. Los municipios deben asegurar el funcionamiento adecuado de los sistemas de desinfección y evitar vertidos cerca de las captaciones (AU)

Objective To investigate a waterborne outbreak in the population of València d’ Àneu (Lleida, Spain).Methods A cohort study of consumption of mains water, bottled water and spring water was carried out. The sample was obtained by telephone contact with all private numbers in the municipality. We surveyed 58.3% of the population census (105/180) for water consumption, number of glasses drunk daily and symptoms. The water supply in the municipal system was sampled, and the presence of Enterobacteriaceae in the stool samples of 10 patients was determined. The association of each type of water was studied with estimation of relative risks (RR) and 95% confidence intervals (95% CI). Results The overall attack rate was 64.8% (68/105). The epidemic curve was consistent with an exposure of 6 days. Consumption of public supply water was associated with gastroenteritis (RR=4.2, 95% CI: 1.5-11.9). In addition, a dose-response relationship was found (χ2=34.1; p <0.001). There was a higher risk of illness in consumers of 2-3 glasses per day (RR=4.3; CI 95%: 1.9-9.9) and in those drinking more than three glasses per day (RR=4.9; 95% CI: 2.2 -10.9). The chlorinator of mains water froze and stopped working. Six stool cultures were positive for Shigella sonnei. Conclusions A waterborne outbreak of S. sonnei was caused by contamination of the public water supply. Investigation of illegal dumping of wastewater was recommended. Municipalities should ensure proper disinfection systems and prevent spillage near deposits (AU)

[Waterborne outbreak of Shigella sonnei caused by consumption of public supply water]. / Brote de gastroenteritis por el consumo de agua de suministro público causado por Shigella sonnei.

OBJECTIVE: To investigate a waterborne outbreak in the population of València d'Àneu (Lleida, Spain). METHODS: A cohort study of consumption of mains water, bottled water and spring water was carried out. The sample was obtained by telephone contact with all private numbers in the municipality. We surveyed 58.3% of the population census (105/180) for water consumption, number of glasses drunk daily and symptoms. The water supply in the municipal system was sampled, and the presence of Enterobacteriaceae in the stool samples of 10 patients was determined. The association of each type of water was studied with estimation of relative risks (RR) and 95% confidence intervals (95% CI). RESULTS: The overall attack rate was 64.8% (68/105). The epidemic curve was consistent with an exposure of 6 days. Consumption of public supply water was associated with gastroenteritis (RR=4.2, 95% CI: 1.5-11.9). In addition, a dose-response relationship was found (χ(2)=34.1; p <0.001). There was a higher risk of illness in consumers of 2-3 glasses per day (RR=4.3; CI 95%: 1.9-9.9) and in those drinking more than three glasses per day (RR=4.9; 95% CI: 2.2 -10.9). The chlorinator of mains water froze and stopped working. Six stool cultures were positive for Shigella sonnei. CONCLUSIONS: A waterborne outbreak of S. sonnei was caused by contamination of the public water supply. Investigation of illegal dumping of wastewater was recommended. Municipalities should ensure proper disinfection systems and prevent spillage near deposits.

High rates of malnutrition in older adults receiving different levels of health care in Lleida, Catalonia: an assessment of contributory factors.

The aim of this study was to define the factors associated with the presence or risk of malnutrition in older adults (>65 years of age) attending health care centers in Lleida, Catalonia, using a cross-sectional study approach. Nutritional parameters assessed included the Mini Nutritional Assessment Scale, sociodemographic and psychosocial factors, functional and cognitive status, swallowing and oral problems, texture and route of administration of the diet, changes in dietary intake, and presence of digestive disorders. A total of 398 individuals (184 men) with an average age of 77 years were included in the assessment. Poor nutritional status was recorded in 58% of the individuals. Factors independently associated with unsatisfactory nutritional status included weight loss, functional dependence, cognitive impairment, loneliness, living without a partner, history of heart disease, lung disease, and the presence of acute vomiting.

Changes in nursing education in the European Union.

PURPOSE: To provide an overview of changes in nursing education in the European Union (EU) within the framework of the Bologna Declaration, signed in 1999 by the European ministers of education, and to describe specific efforts and changes in Spain. ORGANIZING CONSTRUCTS: (a) the Bologna Declaration process, its recent reforms in all disciplines including nursing, and perspectives on future developments; (b) the Tuning Project, designed and carried out by a group of European universities to meet the challenges posed by the Bologna Declaration; and (c) efforts in a group of Spanish universities to promote higher education in nursing. FINDINGS AND CONCLUSIONS: These changes promote enhanced academic recognition, professionalism in nursing education, and graduates' competencies in practice in most European countries by specifying the undergraduate nursing degree as the minimal entrance level for practice and master's and doctoral programs for further career development.

[Outbreak of gastroenteritis caused by Campylobacter jejuni transmitted through drinking water]. / Brote comunitario de gastroenteritis por Campylobacter jejuni originado por el consumo de agua del suministro público.

BACKGROUND: The aim of this study was to conduct a clinical-epidemiological and microbiological investigation into an outbreak of waterborne disease caused by Campylobacter jejuni due to the consumption of drinking water. PATIENTS AND METHOD: A historical cohort study was carried out among 237 residents of Torres de Segre (Lleida, Spain) who were selected using a systematic sample. We conducted a telephone interview about water consumption, symptoms and the onset of disease. We investigated samples of drinking water and stools from 14 patients. The risk associated with each water source was assessed by applying relative risk (RR) analysis at 95% confidence (CI) intervals. RESULTS: The overall attack rate was 18.3% (43/237). The symptoms were: diarrhoea, 93.0% (18/43); abdominal pain, 80.9% (34/42); nausea; 56,1% (23/41); vomits, 42.9% (18/42), and fever, 11.9% (5/42). Only 5.8% of patients contact with his physician. The consumption of drinking water was statistically associated with the disease (RR = 3.0; 95% CI, 1.7-5.3), while the consumption of bottled water (RR = 0.6; 95% CI 0.3-1.0) and water from other villages (RR = 0.3; 95% CI, 0.1-1.1) were a protection factor. The day of outbreak notification we did not detect any residual chlorine in the drinking water: it was qualified as no potable and we isolated Campylobacter jejuni in 8 samples stools. CONCLUSIONS: This research highlights the potential importance of waterborne outbreaks of gastroenteritis due to Campylobacter jejuni transmitted through untreated drinking water and suggests to need systematic controls over drinking water and the proper register of their results.

Brote comunitario de gastroenteritis por Campylobacter jejuni originado por el consumo de agua del suministro público / Outbreak of gastroenteritis caused by Campylobacter jejuni transmitted through drinking water

FUNDAMENTO: El objetivo del estudio fue realizar una investigación clinicoepidemiológica y microbiológica de un brote hídrico de gastroenteritis por Campylobacter jejuni producido por el consumo de agua de la red pública. PACIENTES Y MÉTODO: Se realizó un estudio de cohortes históricas en 237 residentes de Torres de Segre (Lleida) seleccionados mediante un muestreo sistemático del 16,7 per cent (101/605) de los teléfonos particulares. Mediante entrevista telefónica se recogió información sobre el consumo de agua, la presencia de síntomas y la fecha de aparición de síntomas. Se realizó el análisis de una muestra de agua y el coprocultivo de 14 enfermos. Se estudió la implicación de cada tipo de agua con el riesgo relativo (RR) y su intervalo de confianza (IC) del 95 per cent. RESULTADOS: La incidencia en la población fue del 18,3 per cent (43/237), y los enfermos presentaron los siguientes porcentajes de síntomas: diarrea, 93,0 per cent (40/43), dolor abdominal, 80,9 per cent (34/42); náusea, 56,1 per cent (23/41); vómitos, 42,9 per cent (18/42), y fiebre, 11,9 per cent (5/42). Sólo el 5,8 per cent consultó espontáneamente a los servicios médicos. El consumo de agua de la red resultó implicadas (RR = 3,0; IC del 95 per cent, 1,7-5,3), mientras que el consumo de agua embotellada (RR = 0,6; IC del 95 per cent, 0,3-1,0) y aguas de otros municipios (RR = 0,3; IC del 95 per cent 0,1-1,1) resultó ser un factor protector. El día de la notificación del brote no se detectó cloro residual en el agua de la red y la calificación fue de no potable. En ocho coprocultivos se aisló C. jejuni. CONCLUSIONES: El estudio evidencia la posibilidad de presentación de brotes hídricos por C. jejuni por agua de la red no clorada y sugiere la necesidad del control sistemático de las aguas de suministro público y el registro de sus resultados (AU)