Assessing effectiveness of heart rate variability biofeedback to mitigate mental health symptoms: a pilot study.

Introduction: The increasing burden on mental health has become a worldwide concern especially due to its substantial negative social and economic impact. The implementation of prevention actions and psychological interventions is crucial to mitigate these consequences, and evidence supporting its effectiveness would facilitate a more assertive response. Heart rate variability biofeedback (HRV-BF) has been proposed as a potential intervention to improve mental wellbeing through mechanisms in autonomic functioning. The aim of this study is to propose and evaluate the validity of an objective procedure to assess the effectiveness of a HRV-BF protocol in mitigating mental health symptoms in a sample of frontline HCWs (healthcare workers) who worked in the COVID-19 pandemic. Methods: A prospective experimental study applying a HRV-BF protocol was conducted with 21 frontline healthcare workers in 5 weekly sessions. For PRE-POST intervention comparisons, two different approaches were used to evaluate mental health status: applying (a) gold-standard psychometric questionnaires and (b) electrophysiological multiparametric models for chronic and acute stress assessment. Results: After HRV-BF intervention, psychometric questionnaires showed a reduction in mental health symptoms and stress perception. The electrophysiological multiparametric also showed a reduction in chronic stress levels, while the acute stress levels were similar in PRE and POST conditions. A significant reduction in respiratory rate and an increase in some heart rate variability parameters, such as SDNN, LFn, and LF/HF ratio, were also observed after intervention. Conclusion: Our findings suggest that a 5-session HRV-BF protocol is an effective intervention for reducing stress and other mental health symptoms among frontline HCWs who worked during the COVID-19 pandemic. The electrophysiological multiparametric models provide relevant information about the current mental health state, being useful for objectively evaluating the effectiveness of stress-reducing interventions. Further research could replicate the proposed procedure to confirm its feasibility for different samples and specific interventions.

Effectiveness of a Road Traffic Injury Prevention Intervention in Reducing Pedestrian Injuries, Barcelona, Spain, 2002-2019.

This study aimed to evaluate the effectiveness of the Safe Routes to School (SRTS) intervention in Barcelona, Spain, at reducing the number of road traffic collisions and injuries in the school environment. It was a pre-post, quasi-experimental evaluation with a matched comparison group. Road traffic injuries were significantly reduced in the intervention schools-especially among school-age pedestrians-but not in the comparison schools. The SRTS program significantly improved road safety among children. (Am J Public Health. 2023;113(5):495-499. https://doi.org/10.2105/AJPH.2022.307216).

Equine umbilical cord mesenchymal stem cells demonstrate safety and efficacy in the treatment of canine osteoarthritis: a randomized placebo-controlled trial.

OBJECTIVE: To demonstrate the efficacy and safety of mesenchymal stem cells (MSCs) for xenogeneic use with intra-articular administration in dogs with osteoarthritis. ANIMALS: 80 client-owned dogs with naturally occurring osteoarthritis in elbow or hip. PROCEDURES: A multicentric, double-blinded, parallel, randomized and placebo-controlled clinical trial was performed. After intra-articular injection of equine umbilical cord MSCs, dogs were reexamined at weeks 4, 8, and 12 using a force platform (gait analysis), orthopedic assessment, and validated owner questionnaire. Eighteen months after treatment, a long-term follow-up was done. RESULTS: Best results were obtained 8 weeks after treatment, where 63% of the patients showed an improvement in the gait analysis. Also 8 weeks after treatment, 77% of the dogs improved in the orthopedic examination; 65% of the owners considered that the treatment improved their pet's quality of life 8 weeks after treatment. The long-term follow-up revealed that 59% of the owners observed a duration of effect longer than 6 months after a single intra-articular injection of equine umbilical cord MSCs. No systemic or permanent adverse events were detected at any time point. CLINICAL RELEVANCE: Results of this study demonstrated the safety and efficacy of intra-articular administration of xenogeneic MSCs for the treatment of canine osteoarthritis.

Enflicoxib for canine osteoarthritis: A randomized, blind, multicentre, non-inferiority clinical trial compared to mavacoxib.

BACKGROUND: This prospective, multisite, blinded, randomized, non-inferiority clinical study aimed to confirm the efficacy and safety of enflicoxib in the treatment of pain and inflammation associated with canine osteoarthritis. A total of 180 dogs were randomized to receive enflicoxib (n = 78), mavacoxib (n = 80) or placebo (n = 22). Dogs underwent veterinary assessments from day 0 to day 42 using a clinical sum score (CSS). Efficacy was also assessed by the owners using the Canine Brief Pain Inventory (CBPI). The primary efficacy endpoint was the overall CSS from day 0 to day 42. RESULTS: The overall CSS expressed as area under the curve demonstrated non-inferiority of enflicoxib compared to mavacoxib, and both showed superiority over placebo. At the end of the study, average CSS, and the percentage of CSS responders for enflicoxib (3.64 and 74%) and mavacoxib (4.49 and 68%), was superior to placebo (7.15 and 29%). A faster onset of action was observed for enflicoxib as superiority over placebo was evidenced from the first efficacy assessment (day 7) onwards for both parameters, whereas mavacoxib was only significantly different from day 14 onwards. According to the owner assessment, the percentage of CBPI responders was 90%, 79%, and 43% for dogs treated with enflicoxib, mavacoxib and placebo, respectively, and superiority over placebo was demonstrated for both active treatments. In all secondary parameters, non-inferiority of enflicoxib versus mavacoxib was confirmed. The dog's quality of life improved in all groups, but only enflicoxib showed superiority versus placebo. When assessing severely affected dogs only, results were similar, thus confirming the efficacy of enflicoxib in all stages of canine OA. There were no differences between groups in the frequency of adverse events, which were most frequently mild affecting the gastrointestinal tract and recovered without treatment. CONCLUSIONS: Enflicoxib is efficacious and safe for the treatment of pain and inflammation in any stage of canine osteoarthritis with a faster onset of action compared to mavacoxib.

Efficacy and safety of enflicoxib for treatment of canine osteoarthritis: A 6-week randomised, controlled, blind, multicentre clinical trial.

BACKGROUND: Enflicoxib is a new COX-2 selective NSAID intended for the treatment of pain and inflammation associated with canine osteoarthritis. METHODS: A prospective, multisite, blinded, randomised, controlled, parallel-group field study was performed to determine the efficacy and safety of enflicoxib in canine osteoarthritis. A total of 242 dogs were randomised to receive enflicoxib at 4 or 2 mg/kg, mavacoxib at 2 mg/kg or placebo, orally. Enflicoxib and placebo were administered once weekly from day 0 to day 35. Mavacoxib was administered on D0 and day 14. Veterinarians assessed efficacy with a numerical rating scale and owners used the Canine Brief Pain Inventory. RESULTS: After 6 weeks, enflicoxib at 4 mg/kg showed the highest percentage of responders as assessed by the veterinarians (68%) and the owners (84%), followed by mavacoxib (62and 83%, respectively), and enflicoxib at 2 mg/kg (57 and 80%, respectively). All treatments reached statistical significance versus placebo, which obtained success rates of 37% and 53%, respectively. No differences in the incidence of adverse reactions were detected among the different groups. CONCLUSIONS: Enflicoxib administered weekly for 6 weeks, at 4 mg/kg PO with an initial loading dose of 8 mg/kg, is efficacious and safe for the treatment of canine osteoarthritis.

Towards a statistically robust determination of minimum water potential and hydraulic risk in plants.

Minimum water potential (Ψmin ) is a key variable for characterizing dehydration tolerance and hydraulic safety margins (HSMs) in plants. Ψmin is usually estimated as the absolute minimum tissue Ψ experienced by a species, but this is problematic because sample extremes are affected by sample size and the underlying probability distribution. We compare alternative approaches to estimate Ψmin and assess the corresponding uncertainties and biases; propose statistically robust estimation methods based on extreme value theory (EVT); and assess the implications of our results for the characterization of hydraulic risk. Our results show that current estimates of Ψmin and HSMs are biased, as they are strongly affected by sample size. Because sampling effort is generally higher for species living in dry environments, the differences in current Ψmin estimates between these species and those living under milder conditions are partly artefactual. When this bias is corrected using EVT methods, resulting HSMs tend to increase substantially with resistance to embolism across species. Although data availability and representativeness remain the main challenges for proper determination of Ψmin , a closer look at Ψ distributions and the use of statistically robust methods to estimate Ψmin opens new ground for characterizing plant hydraulic risks.

Influence of Visitors on the Time Budget, Ranging and Strata Use of Lowe's Monkey (Cercopithecus lowei) at Boabeng-Fiema Monkey Sanctuary, Ghana.

Wildlife tourism could be a conservation tool; however, it may disrupt the natural behaviors of wild animals. We examined how wildlife tourism affects Lowe's monkeys (Cercopithecus lowei) at the Boabeng-Fiema Monkey Sanctuary, central Ghana. We examined and compared the time budget, aggression patterns, home range size and strata use of two C. lowei groups-one with a high level of provisioning by visitors/tour guides (HP group) versus one with a low level of provisioning by visitors/tour guides (LP group). We found evidence that the HP group fed less and rested more than the LP group. The HP group significantly increased the time spent feeding and decreased their time resting, but no significant differences were recorded for moving or socializing either in the presence of small or big groups of visitors (i.e., 1-10 visitors or > 10 visitors). In the presence of one to ten visitors, the HP group monkeys increased the use of ground by 22.10% and decreased the use of medium and high tree strata by 15.43% and 11.6%, respectively. Agonistic behaviors (i.e., threat, chase, and attack) were three times higher in the HP group (e.g., open-jawed gaze gesture or head-bobbing). In the presence of visitors, aggression in the HP group increased from 12.81% to 30.18%. The home range size of the C. lowei HP group was smaller (4.68 ha) compared to the LP group (14.25 ha) (i.e., 50.56% difference). The LP group spent significantly less time socializing and more time moving. They fed more on fruits and insects. On average, the daily travel of LP group was 0.58 km more than the HP group (i.e., 22.80% difference), and the former group also spent significantly more time in the mid strata of the canopy. Our results showed that continued provisioning of the monkeys with human foods is detrimental to their natural behavior of the monkeys and could have negative long-term effects on the conservation efforts for the species.

Heart to spine measurements to detect left atrial enlargement in dogs with mitral insufficiency.

BACKGROUND: Radiography is useful to determine left atrial (LA) size when echocardiography is not available. Recently, the authors have described Radiographic Left Atrial Dimension (RLAD) as a new radiographic measurement to assess LA size. The objective of this study was to assess the clinical usefulness of 2 new radiographic measurements to detect and quantify left atrial enlargement (LAE) compared to RLAD and using left atrium to aortic root (LA/Ao) ratio as gold standard. These new measurements, bronchus-to-spine (Br-Spine) and RLAD-to-spine (RLAD-Spine) may be more precise in cases were LA boundaries are not well defined. Fifty dogs, 25 with and 25 without LAE were recruited. Reference LA/Ao ratio was assessed by 2D echocardiography and LAE was considered if LA/Ao > 1.6. Br-spine was measured as a straight vertical line from the main stem bronchus to the ventral border of the vertebra situated immediately dorsal to the heart base. RLAD-Spine was measured from RLAD endpoint perpendicularly to spine. The correlation of RLAD, Br-Spine and RLAD-Spine methods with LA/Ao and their sensitivity and specificity for detecting LAE were calculated. Receiver Operating Characteristic (ROC) curves were used to estimate the optimal cut-off for each method. RESULTS: Correlations between Br-Spine, RLAD-Spine, RLAD and LA/Ao ratio were - 0.66, - 0.76 and 0.89 respectively (P < 0.001). Sensitivity at the optimal cut-off values for detecting LAE were 32.0, 64.0 and 96.0%, respectively. Specificity was 96.0% in all cases. CONCLUSION: Br-Spine and RLAD-Spine were less sensitive radiographic measurements than RLAD in detecting LAE in dogs. Both Br-Spine and RLAD-Spine may not be good alternatives to RLAD.

A statistical approach to improve compound screening in cell culture media.

The Chinese hamster ovary (CHO) cell line is widely used for the production of recombinant proteins due to its high growing capacity and productivity, as well as other cell lines derived later than CHO. Adapting cell culture media for each specific cell line is a key to exploit these features for cost effective and fast product generation. Media supplementation is generally addressed by means of one-factor-at-a-time or classical design of experiments approaches but these techniques may not be efficient enough in preliminary screening phases. In this study, a novel strategy consisting in folding over the Plackett-Burman design was used to increase cell growth and trastuzumab production of different CHO cell lines through supplementation with nonanimal recombinant compounds. Synergies between compounds could be detected with a reduced number of experiments by using this methodology in comparison to more conventional fractional factorial designs. In the particular case reported here, the sequential use of this modified Plackett-Burman in combination with a Box-Behnken design led to a 1.5-fold increase in cell growth (10 × 106 cells/mL) and a two-fold in trastuzumab titer (122 mg/L) in suspension batch culture.

Protected Natural Areas: In Sickness and in Health.

Numerous studies show the benefits that contact with the natural environment have for human health, but there are few studies on the role of Protected Natural Areas (PNAs), either from the preventive point of view or on their potential benefits, on individuals with health problems. A study was made of the relationship between the visitation of Montseny Natural Park and Biosphere Reserve and health, from the perspective of a population group with different diseases. A total of 250 patients resident in the areas near the park were surveyed, recording their beliefs about the benefits of nature, as well as the reasons for visiting and the activities associated with health that they carried out in the park. The pure air is the most valued benefit (27.2%), particularly for those with allergies. The majority (57%) visit the park for health reasons. High levels (82%) of exercise are recorded, especially by patients with heart diseases (85%), and 65% exercised in the park. More physical activity is mentioned among those that visit the park most often, particularly among those that carried it out for health reasons. Plants were collected for medicinal use by 39.6%. The study confirmed the significant role of the Montseny Natural Park and Biosphere Reserve as a health resource for individuals with diseases that live near it. It also corroborates the beneficial effects that the PNA provide in human health.

Seasonal Variability of the Phytochemical Composition of New Red-Fleshed Apple Varieties Compared with Traditional and New White-Fleshed Varieties.

The main objective of this study was to evaluate the impact of the season on the apple phytochemical composition (phenolic compounds, triterpenes, and organic and ascorbic acids). For this proposal, four red-fleshed and five white-fleshed apple varieties from two consecutive seasons (2015 and 2016) were studied. A significant interaction with the season in some compounds was observed. The total phenolic content in the apple flesh from 2015 was higher than that from 2016 probably related with the lower rainfall during the harvest period in 2015 that could have favored hydric stress in the apple trees. The impact of the season on the apple skin was different. The 2016 season was characterized by higher maximum and minimum temperatures resulting in a higher content of flavonols, triterpenes, and organic acids. Anthocyanin concentration in both the flesh and skin of the red-fleshed apples showed no clear relationship to the season, and each variety showed an individual pattern.

Azacitidine improves outcome in higher-risk MDS patients with chromosome 7 abnormalities: a retrospective comparison of GESMD and GFM registries.

Treatment with azacitidine (AZA) has been suggested to be of benefit for higher-risk myelodysplastic syndrome (HR-MDS) patients with chromosome 7 abnormalities (Abn 7). This retrospective study of 235 HR-MDS patients with Abn 7 treated with AZA (n = 115) versus best supportive care (BSC; n = 120), assessed AZA treatment as a time-varying variable in multivariable analysis. A Cox Regression model with time-interaction terms of overall survival (OS) at different time points confirmed that, while chromosome 7 cytogenetic categories (complex karyotype [CK] versus non-CK) and International Prognostic Scoring System risk (high versus intermediate-2) retained poor prognosis over time, AZA treatment had a favourable impact on OS during the first 3 years of treatment compared to BSC (Hazard ratio [HR] 0·5 P < 0·001 at 1 year, 0·7 P = 0·019 at 2 years; 0·73 P = 0·029 at 3 years). This benefit was present in all chromosome 7 categories, but tended to be greater in patients with CK (risk reduction of 82%, 68% and 53% at 1, 3 and 6 months in CK patients; 79% at 1 month in non-CK patients, P < 0·05 for all). AZA also significantly improved progression-free survival (P < 0·01). This study confirms a time-dependent benefit of AZA on outcome in patients with HR-MDS and cytogenetic abnormalities involving chromosome 7, especially for those with CK.

Spherical subjective refraction with a novel 3D virtual reality based system / Refracción subjetiva esférica utilizando un nuevo sistema 3D basado en realidad virtual

Purpose: To conduct a clinical validation of a virtual reality-based experimental system that is able to assess the spherical subjective refraction simplifying the methodology of ocular refraction. Methods: For the agreement assessment, spherical refraction measurements were obtained from 104 eyes of 52 subjects using three different methods: subjectively with the experimental prototype (Subj.E) and the classical subjective refraction (Subj.C); and objectively with the WAM-5500 autorefractor (WAM). To evaluate precision (intra- and inter-observer variability) of each refractive tool independently, 26 eyes were measured in four occasions. Results: With regard to agreement, the mean difference (±SD) for the spherical equivalent (M) between the new experimental subjective method (Subj.E) and the classical subjective refraction (Subj.C) was −0.034 D (±0.454 D). The corresponding 95% Limits of Agreement (LoA) were (−0.856 D, 0.924 D). In relation to precision, intra-observer mean difference for the M component was 0.034 ± 0.195 D for the Subj.C, 0.015 ± 0.177 D for the WAM and 0.072 ± 0.197 D for the Subj.E. Inter-observer variability showed worse precision values, although still clinically valid (below 0.25 D) in all instruments. Conclusions: The spherical equivalent obtained with the new experimental system was precise and in good agreement with the classical subjective routine. The algorithm implemented in this new system and its optical configuration has been shown to be a first valid step for spherical error correction in a semiautomated way (AU)

Objetivo: Realizar una validación clínica de un sistema experimental basado en realidad virtual, capaz de evaluar la refracción subjetiva esférica simplificando la metodología de la refracción ocular. Métodos: Para evaluar la concordancia, se obtuvieron mediciones de la refracción esférica de 104 ojos pertenecientes a 52 sujetos, utilizando tres métodos diferentes: subjetivamente con el prototipo experimental (Subj.E) y la refracción subjetiva clásica (Subj.C); y objetivamente con el autorrefractómetro WAM-5500 (WAM). Para evaluar la precisión (variabilidad intra e inter-observador) de cada herramienta refractiva, de forma independiente, se midieron 26 ojos en cuatro ocasiones. Resultados: Con respecto a la concordancia, la diferencia media (±DE) para el equivalente esférico (M) entre el nuevo método subjetivo experimental (Subj.E) y la refracción subjetiva clásica (Subj.C) fue de −0,034 D (±0,454 D). El 95% correspondiente a los Límites de la Concordancia (LoA) fue de (−0,856 D, 0,924 D). En relación a la precisión, la diferencia media intra observador para el componente M fue de 0,034 ± 0,195 D para Subj.C, 0,015 ± 0,177 D para WAM y 0,072 ± 0,197 D para Subj.E. La variabilidad inter observador reflejó peores valores de precisión, aunque fueron clínicamente válidos (inferiores a 0,25 D) en todos los instrumentos. Conclusiones: El equivalente esférico obtenido con el nuevo sistema experimental fue preciso y guardó consonancia con la rutina subjetiva clásica. El algoritmo introducido en este nuevo sistema, y su configuración óptica, han demostrado ser un avance válido para la corrección del error esférico de modo semi-automático (AU)

Spherical subjective refraction with a novel 3D virtual reality based system.

PURPOSE: To conduct a clinical validation of a virtual reality-based experimental system that is able to assess the spherical subjective refraction simplifying the methodology of ocular refraction. METHODS: For the agreement assessment, spherical refraction measurements were obtained from 104 eyes of 52 subjects using three different methods: subjectively with the experimental prototype (Subj.E) and the classical subjective refraction (Subj.C); and objectively with the WAM-5500 autorefractor (WAM). To evaluate precision (intra- and inter-observer variability) of each refractive tool independently, 26 eyes were measured in four occasions. RESULTS: With regard to agreement, the mean difference (±SD) for the spherical equivalent (M) between the new experimental subjective method (Subj.E) and the classical subjective refraction (Subj.C) was -0.034D (±0.454D). The corresponding 95% Limits of Agreement (LoA) were (-0.856D, 0.924D). In relation to precision, intra-observer mean difference for the M component was 0.034±0.195D for the Subj.C, 0.015±0.177D for the WAM and 0.072±0.197D for the Subj.E. Inter-observer variability showed worse precision values, although still clinically valid (below 0.25D) in all instruments. CONCLUSIONS: The spherical equivalent obtained with the new experimental system was precise and in good agreement with the classical subjective routine. The algorithm implemented in this new system and its optical configuration has been shown to be a first valid step for spherical error correction in a semiautomated way.

Effectiveness and safety of different azacitidine dosage regimens in patients with myelodysplastic syndromes or acute myeloid leukemia.

We investigated the effectiveness and tolerability of azacitidine in patients with World Health Organization-defined myelodysplastic syndromes, or acute myeloid leukemia with 20-30% bone marrow blasts. Patients were treated with azacitidine, with one of three dosage regimens: for 5 days (AZA 5); 7 days including a 2-day break (AZA 5-2-2); or 7 days (AZA 7); all 28-day cycles. Overall response rates were 39.4%, 67.9%, and 51.3%, respectively, and median overall survival (OS) durations were 13.2, 19.1, and 14.9 months. Neutropenia was the most common grade 3-4 adverse event. These results suggest better effectiveness-tolerability profiles for 7-day schedules.

Effect of perphenazine enanthate on open-field test behaviour and stress-induced hyperthermia in domestic sheep.

The open-field test (OFT) and stress-induced hyperthermia (SIH) have been used to measure individual differences in fear. The present study has been designed as a pharmacological validation of OFT and SIH as indicators of fear in sheep using perphenazine enanthate (PPZ), a long-acting neuroleptic. Twenty four ewes of two breeds, Lacaune and Ripollesa, were tested in an arena measuring 5mx2.5m. Treatment group received one dose of 1.5mg/kg of PPZ and control group received sterile sesame oil. All animals were tested for 10min and behaviours were recorded. Rectal temperature was measured at the beginning (T1) and at the end (T2) of the test. SIH was defined as the difference between T2 and T1. Sheep were tested on days 1, 2, 3, 4, 7 and 9 after PPZ injection. Variables were analysed using a mixed model. PPZ decreased bleats on days 2, 3, 4 and the SIH response on days 2 and 3. Breed differences were observed. Treated animals showed positive correlations between SIH and bleats; squares entered; attempts to escape and negative correlation between SIH and visits to the food bucket. Our results suggest that behaviour and SIH on the OFT are useful measures of fear in sheep.

Evolution of the BSE epidemic in Catalonia (1990-2015) based on a stochastic model.

A stochastic model was used to estimate the number of bovine spongiform encephalopathy (BSE) cases that may have occurred in Catalonia (north-east Spain) from January 1990 to December 2015. The model allowed the evolution of the unobserved cases to be estimated differentiating the population into two subgroups: (1) livestock slaughtered for human consumption without clinical signs and (2) cattle at increased risk (including fallen stock, clinical suspects, emergency slaughtered cattle and cattle with clinical signs at ante mortem inspection). If the first bovine affected by BSE had been introduced into the region in 1986, the model predicted that during the period of study the surveillance system would detect a median of 197 outbreaks (2.5-97.5 percentiles: 157-245). The estimated median number of outbreaks that may have appeared before the establishment of the monitoring program was 80 (2.5-97.5 percentiles: 35-152), and the number of cases would have peaked in 2001.

Women, patients with severe asthma, and patients attended by primary care physicians, are at higher risk of suffering from poorly controlled asthma.

AIM: The aim of this exploratory study was to identify those factors associated with asthma control assessed according to GINA Guidelines. METHOD: 809 (56% female) subjects with asthma were recruited consecutively from both specialist and primary care centres. Asthma control was assessed over a 4-week follow-up period using a composite measure. A multivariate analysis was performed, in which asthma control was included as the dependent variable and several explanatory variables were included as independent variables. RESULTS: Analysis performed on the whole population rendered gender (p=0.003), the type of physician (p<0.001), and age group (p<0.001), as significant factors associated with asthma control. In adults, gender (p=0.001), asthma severity (p<0.001), and type of physician (p<0.001) were significant, and only asthma severity was significant (p=0.043) in children. CONCLUSIONS: After model adjustment, we suggest that being female, suffering from more severe asthma, or being attended by a primary care physician, could pose a significantly higher risk of having poorly controlled asthma in adults.

[Factors associated with patient satisfaction and care of over 65 year olds in emergency departments]. / Factores asociados con la satisfacción en el cuidado y la asistencia en el departamento de cirugía de urgencias de los pacientes mayores de 65 años.

INTRODUCTION: The population over 65 years old represents 40-50% of the all visits made to an emergency department (ED). Some situations of stress and dehumanization can occur due to user overflow. Our target is to identify factors influencing overall satisfaction of patients older than 65 attended in the ED, in order to identify points of conflict and improve the deficiencies in our care. MATERIAL AND METHOD: We performed a prospective study from September 2005-June 2006 with those patients who accepted to take part by filling an anonymous and confidential questionnaire. We evaluated 19 epidemiological variables, medical and related to the quality of information provided. A single bivariate analysis was performed (chi2, t-Student or logistic regression). RESULTS: The questionnaire was filled out by 1389 (31.3%) out of 4437 patients that could potentially be included in the study. Mean patient age was 77 +/- 6 years and more than half of them were women (64%). Of the responses, 82% rated their ED care as excellent or good. Variables significantly related to satisfaction were perception of a not-too-long waiting time (p = 0.001), having been attended to previously in the hospital (p = 0.050), having explained the tests that patients had to undergo (p = 0.002) and having been given clear information from staff (p = 0.001). CONCLUSIONS: In order to improve the quality of care given in the ED, the staff should give more personalized and clear information and reduce the patient perception that waiting time is too long.

Factores asociados con la satisfacción en el cuidado y la asistencia en el departamento de cirugía de urgencias de los pacientes mayores de 65 años / Factors associated with patient satisfaction and care of over 65 year olds in emergency departments

Introducción. La población de 65 años o más es el 40-50% de las visitas de un departamento de urgencias (DU). Dada la afluencia de algunas veces, se producen situaciones de tensión e incluso de deshumanización en la asistencia. El objetivo de nuestro trabajo es mostrar y analizar los factores que influyen en la satisfacción global de los pacientes mayores de 65 años, atendidos en el DU, para poder identificar puntos potencialmente conflictivos y resolver las carencias de nuestra asistencia diaria. Material y método. Realizamos un estudio prospectivo entre septiembre de 2005 y junio de 2006, con los pacientes que aceptaron participar y que rellenaron un cuestionario anónimo y confidencial. Evaluamos 19 variables epidemiológicas, médicas y relacionadas con la calidad de la información recibida; se realizó un análisis bivariante (x2, t de Student) para seleccionar las variables relacionadas con un mayor grado de satisfacción en nuestra serie. Resultados. Cumplimentaron el cuestionario 1.389 (31,3%) de 4.437 pacientes que podían ser incluidos. La media de edad de los pacientes fue 77 ± 6 años. Más de la mitad eran mujeres (64%). El 82% de los pacientes puntuaron la asistencia global recibida en urgencias como excelente o buena. Las variables relacionadas significativamente con un alto grado de satisfacción global fueron la percepción de un tiempo de espera no demasiado largo (p = 0,001), haber sido atendido con anterioridad (p = 0,050), haber recibido una información adecuada por parte del personal médico (haber explicado las razones para solicitar pruebas complementarias [p = 0,002] y comunicar el resultado de estas exploraciones [p = 0,001]). Conclusiones. Para mejorar la calidad de la asistencia en el DU debemos aportar una información más personalizada y concisa, así como reducir la percepción del paciente de que el tiempo de espera es demasiado largo (AU)

Introduction. The population over 65 years old represents 40-50% of the all visits made to an emergency department (ED). Some situations of stress and dehumanization can occur due to user overflow. Our target is to identify factors influencing overall satisfaction of patients older than 65 attended in the ED, in order to identify points of conflict and improve the deficiencies in our care. Material and method. We performed a prospective study from September 2005-June 2006 with those patients who accepted to take part by filling an anonymous and confidential questionnaire. We evaluated 19 epidemiological variables, medical and related to the quality of information provided. A single bivariate analysis was performed (x2, t-Student or logistic regression). Results. The questionnaire was filled out by 1389 (31.3%) out of 4437 patients that could potentially be included in the study. Mean patient age was 77 ± 6 years and more than half of them were women (64%). Of the responses, 82% rated their ED care as “excellent” or “good”. Variables significantly related to satisfaction were perception of a not-too-long waiting time (p = 0.001), having been attended to previously in the hospital (p = 0.050), having explained the tests that patients had to undergo (p = 0.002) and having been given clear information from staff (p = 0.001). Conclusions. In order to improve the quality of care given in the ED, the staff should give more personalized and clear information and reduce the patient perception that waiting time is too long (AU)