Comorbidities of Primary Care patients with COVID-19 during the first wave of the SARS-CoV-2 pandemic in the Community of Madrid / Comorbilidades de los pacientes con COVID-19 atendidos en Atención Primaria durante la primera oleada de la pandemia de SARSCoV-2 en la Comunidad de Madrid

Objectives. Recent publications on inpatients with COVID-19 describing their comorbidities and demographic profile exists, but data from large populations requiring only primary care (PC) are scarce. This paper aims to fill this gap and report the prevalence of eight comorbidities (high blood pressure, diabetes mellitus, cancer, cardiovascular disease, asthma, chronic kidney disease, chronic obstructive pulmonary disease, and chronic heart failure) among patients attending PC during the onset of the SARS-CoV-2 pandemic in the Community of Madrid (CoM), Spain. Patients and methods. This is an observational retrospective study that collects data registered in the CoM between February 25th and May 31st, 2020. Data are divided in two groups: Group-1 (N=339,890) consist of all patients with suspected or proven SARS-CoV-2 infection; and Group-2 is the subgroup (N=48,556, 14.3% of Group-1) of individuals with COVID-19 confirmed by positive RT-PCR test. Results. Comparing Group-1 with Group-2, 339,890/48,556 patients, respectively, the main results were as follows: average age (60.9/69.9 years), presence of at least one comorbidity (33.51%/47.69%), high blood pressure (19.74%/32.74%), diabetes mellitus (7.13%/13.75%), cancer (6.56%/10.6%), cardiovascular disease (4.52%/9.26%), asthma (7.98%/6.56%), chronic kidney disease (1.84%/4.41%), chronic obstructive pulmonary disease (2%/4.03%), and chronic heart failure (1.14%/2.77%). High blood pressure and diabetes mellitus were seen to be the most frequent (6.56%/8.38%) association. Conclusions. Patients requiring PC attention during the first wave of the COVID-19 pandemic in the CoM presented with a very high rate of comorbidities, with marked differences among those with or without a confirmed SARS-CoV-2 infection. (AU)

Objetivos. Existen publicaciones sobre las comorbilidades y el perfil demográfico en pacientes hospitalizados por COVID-19, pero son escasas aquellas sobre grandes poblaciones atendidas en Atención Primaria (AP). El objetivo de este trabajo es llenar este vacío describiendo la prevalencia de ocho comorbilidades (hipertensión arterial, diabetes mellitus, cáncer, enfermedad cardiovascular, asma, enfermedad renal crónica, enfermedad pulmonar obstructiva crónica e insuficiencia cardíaca crónica) en los pacientes de AP durante el inicio de la pandemia por SARS-CoV-2 en la Comunidad de Madrid (CoM), España. Pacientes y métodos. Estudio observacional retrospectivo que recopila datos registrados en la CoM, entre el 25 de febrero y el 31 de mayo de 2020. Se diferencian dos cohortes de pacientes que acudieron a AP: Grupo-1 (N=339.890), que incluye todos los pacientes con sospecha de SARS-CoV-2 o infección confirmada; Grupo-2, que es el subgrupo (N= 48.556, 14,3% del Grupo-1) de casos confirmados de COVID-19 mediante prueba RT-PCR. Resultados. Comparando el Grupo-1 con el Grupo-2 (339.890/48.556 pacientes, respectivamente), los principales resultados fueron los siguientes: edad media (60,9/69,9 años), presencia de al menos una comorbilidad (33,51%/47,69%), hipertensión arterial (19,74%/32,74%), diabetes mellitus (7,13%/13,75%), cáncer (6,56%/10,6%), enfermedad cardiovascular (4,52%/9,26%), asma (7,98%/6,56%), enfermedad renal crónica (1,84%/4,41%), EPOC (2%/4,03%) e insuficiencia cardíaca crónica (1,14%/2,77%). La asociación más frecuente fue hipertensión arterial y diabetes (6,56%/8,38%). Conclusiones. Los pacientes atendidos en AP durante la primera ola de la actual pandemia de COVID-19 en la CoM presentaron una tasa muy alta de una o más comorbilidades comunes, con diferencias significativas según tuvieran una infección confirmada o no por SARS-CoV-2. (AU)

Flexibility and Bed Margins of the Community of Madrid's Hospitals during the First Wave of the SARS-CoV-2 Pandemic.

Background: The COVID-19 pandemic has had global effects; cases have been counted in the tens of millions, and there have been over two million deaths throughout the world. Health systems have been stressed in trying to provide a response to the increasing demand for hospital beds during the different waves. This paper analyzes the dynamic response of the hospitals of the Community of Madrid (CoM) during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the period between 18 March and 31 May 2020. The aim was to model the response of the CoM's health system in terms of the number of available beds. Methods: A research design based on a case study of the CoM was developed. To model this response, we use two concepts: "bed margin" (available beds minus occupied beds, expressed as a percentage) and "flexibility" (which describes the ability to adapt to the growing demand for beds). The Linear Hinges Model allowed a robust estimation of the key performance indicators for capturing the flexibility of the available beds in hospitals. Three new flexibility indicators were defined: the Average Ramp Rate Until the Peak (ARRUP), the Ramp Duration Until the Peak (RDUP), and the Ramp Growth Until the Peak (RGUP). Results: The public and private hospitals of the CoM were able to increase the number of available beds from 18,692 on 18 March 2020 to 23,623 on 2 April 2020. At the peak of the wave, the number of available beds increased by 160 in 48 h, with an occupancy of 90.3%. Within that fifteen-day period, the number of COVID-19 inpatients increased by 200% in non-intensive care unit (non-ICU) wards and by 155% in intensive care unit (ICU) wards. The estimated ARRUP for non-ICU beds in the CoM hospital network during the first pandemic wave was 305.56 beds/day, the RDUP was 15 days, and the RGUP was 4598 beds. For the ICU beds, the ARRUP was 36.73 beds/day, the RDUP was 20 days, and the RGUP was 735 beds. This paper includes a further analysis of the response estimated for each hospital. Conclusions: This research provides insights not only for academia, but also for hospital management and practitioners. The results show that not all of the hospitals dealt with the sudden increase in bed demand in the same way, nor did they provide the same flexibility in order to increase their bed capabilities. The bed margin and the proposed indicators of flexibility summarize the dynamic response and can be included as part of a hospital's management dashboard for monitoring its behavior during pandemic waves or other health crises as a complement to other, more steady-state indicators.

La arquitectura hospitalaria y el ingreso de pacientes infecciosos de alto riesgo / No disponible

Desde sus inicios, los hospitales tuvieron que acoger a enfermos con enfermedades infecciosas con el riesgo de transmitirlas a los no infectados, aunque solo desde los tiempos de la Ilustración se construyó pensando en evitarlo. En fechas más recientes algunas organizaciones, como AIA y CDC norteamericanas, recomendaron precauciones para el ingreso de infecciosos según criterios epidemiológicos, entre ellas el aislamiento ante infecciones de transmisión aérea, así como las características de las habitaciones donde ingresarles (AIIRs). Asimismo se han establecido las condiciones ambientales de las áreas hospitalarias en dependencia al riesgo infeccioso, en España a través de Normas UNE, como la 100713 y la 171340. La aparición de diversas fiebres hemorrágicas víricas (FHV), de alta contagiosidad, ha creado preocupación e impulsado normas que tienen presente el aislamiento. Se revisa el contenido de todas ellas y se hacen consideraciones sobre la adaptación del espacio hospitalario ante las potenciales demandas de aislamiento (AU)

Since its inception, hospitals had to accommodate patients with infectious diseases, taking the risk of transmission to the uninfected, if only from the Enlightenment were those built thinking about avoiding this. More recently, some northamerican organizations such as AIA and CDC recommended precautions to the entry of infectious patients following epidemiological criteria, including isolation against airborne infections, as well as the characteristics of the rooms where those patients should enter (AIIRs). Besides, environmental conditions of infectious risk in hospital areas dependence have been established in Spain through UNE (100713 and 171340). The appearance of several high contagious viral hemorrhagic fevers (VHF) created concern and standards that take into account isolation have been established. All content is reviewed and considerations on the adaptation of hospital space to the potential demands of isolation are made (AU)

Análisis de redes y medicina: una nueva perspectiva / Network analysis and medicine: a new perspective

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Tecnología, demanda social y “medicina del deseo” / Technology, social requirement, and ‘‘wish - fulfilling medicine’’

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Respuesta. A propósito del suceso de la médico residente N.M.N

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[Epidemiological surveillance of pulmonary tuberculosis treated at the specialized care level based on 2 data sources, Valladolid; Spain]. / Vigilancia epidemiológica de la tuberculosis pulmonar atendida en el nivel especializado a partir de dos fuentes de información, Valladolid.

BACKGROUND: Pulmonary tuberculosis is still more frequent that it should be in Spain given the degree of Spain's social and healthcare-related development. Apart from some individual studies, such as the Multicenter Tuberculosis Research Project, the incidence of tuberculosis is known by way of the Compulsory Notifiable Disease System, in which some degree of under-notification has been detected. The question has been raised as to whether this data can be improved through the additional use of another registry, specifically the Minimum Basic Data Set (MBDS). METHODS: This is a retrospective study referring back to the 1996-2000 period conducted on the population of a healthcare district totaling 220,572 inhabitants. The data from the Compulsory Notifiable Disease registry was used to the specialized care level, and that of the MBDS registry for the diagnosis of pulmonary tuberculosis. The incidence rates were calculated for each source by the capture-recapture method. An analysis was made of epidemiological characteristics such as age, gender, place of residence, bacillus in sputum and treatment data on the hospitalized cases, such as average length of stay, type of admission, type of release, clinical department, HIV co-morbility. RESULTS: The mean annual incidence recorded at the specialized care level was 16.6 cases/100,000 inhabitants in the Compulsory Notifiable Disease registry; 20.4 cases/100,000 inhabitants in the MBDS registry, and 23.1 cases/100,000 inhabitants combining both of these two sources. The incidence estimated using the capture-recapture method was that of 24.4 cases/100,000 inhabitants (IC95%: 23.5-25.3). CONCLUSIONS: Any information system which provides reliable data serves to improve epidemiological surveillance even though it may have been designed for a different purpose. It is all a matter of knowing the limitations and unique aspects thereof. The MBDS provides information of epidemiological interest which is not included in the Compulsory Notifiable Disease reports. Using the capture-recapture method is one alternative for estimating truer pulmonary tuberculosis rates.

¿Pudo haberse evitado lo que le sucedió a la médicoresidente N.M.N.? / Kills by a Spanish medical resident. Could them be avoided?

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Vigilancia epidemiológica de la tuberculosis pulmonar atendida en el nivel especializado a partir de dos fuentesde información, Valladolid / Epidemiological surveillance of pulmonary tuberculosis treated at the specialized care level based on two data sources, Valladolid, Spain

Fundamento: La tuberculosis pulmonar en España tiene una frecuencia superior a la que le correspondería, dado su desarrollo social y sanitario. Aparte de algunos estudios puntuales, la incidencia se conoce a partir del Sistema de Notificación como Enfermedad de Declaración Obligatoria (EDO), en el que se ha detectado algún grado de infradeclaración. Se ha planteado si se puede mejorar esta información empleando además otro registro, concretamente el Conjunto Mínimo Básico de Datos (CMBD). Métodos: Se trata de un estudio retrospectivo del periodo 1996-2000, llevado a cabo en la población de un área de salud de 220.572 habitantes. Se han utilizado los datos del registro EDO en el nivel de asistencia especializada y los del registro CMBD con el diagnóstico de tuberculosis pulmonar. Se calcularon las tasas de incidencia para cada fuente y según el método captura-recaptura. Se analizaron características epidemiológicas de las personas como: edad, género, lugar de residencia, condición de bacilífero, y datos asistenciales de los casos ingresados como, estancia media, tipo de ingreso, tipo de alta, servicio clínico. Resultados: La incidencia media anual registrada en el nivel de atención especializada fue de 16,6 por 105 habitantes en el registro EDO, 20,4 casos por 105 habitantes en el CMBD y de 23,1 por 105 habitantes combinando ambas fuentes. La incidencia estimada con el método captura-recaptura fue de 24,4 por 105 hab. (IC95 por ciento: 23,525,3). Conclusiones: Cualquier sistema de información que aporte datos fiables sirve para mejorar la vigilancia epidemiológica aunque haya sido diseñado con otro fin. Se trata de conocer sus limitaciones y peculiaridades. El CMBD proporciona información de interés epidemiológico no contenida en los partes de EDO. La aplicación del método captura-recaptura es una alternativa para estimar tasas más reales de tuberculosis pulmonar (AU)

Una plaza fija para toda la vida / A secure job for ever

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