[Professional and psychological impact of second victims among hospital healthcare professionals]. / Impacto laboral y psicológico de las segundas víctimas entre los profesionales sanitarios hospitalarios.

OBJECTIVE: To analyze the occupational and psychological consequences suffered by healthcare workers who are considered second victims (SV). MATERIAL AND METHODS: Observational, descriptive and cross-sectional study among the healthcare workers of a university hospital. The answers collected in a specifically designed questionnaire about psychological consequences at work and the result of a post-traumatic stress scale, "Impact of Event Scale-Revised (IES-R, spanish version)" were evaluated. The variables between the groups were compared using the Chi square test (or Fisher's exact test) when both were qualitative and with the Student's T (or the Mann-Whitney U test for independent data), when one of them was quantitative. The level of statistical significance was P<.05. RESULTS: 75.5% (148/207) of the participants in the study suffered some adverse event (AE) and, of these, 88.5% (131/148) were considered SV. Physicians had a 2.2 times higher risk of feeling SV than nurses (95% CI: 1.88-2.52). The impact on the patient related to the AE explained why the professionals involved in it felt SV (P=.037). 80.6% (N=104) of the SVs presented post-traumatic stress. Women were 2.4 times more likely to suffer from it (OR: 2.4; 95% CI: 1.5-4.0). Intrusive thoughts in the SV were almost three times more frequent when the damage suffered by the patient was permanent or death (OR: 2.5; 95% CI: 0.2-3.6). CONCLUSIONS: Many healthcare workers, especially physicians, considered themselves to be SV, and many of them suffered from post-traumatic stress. The impact on the patient related to the AE was a risk factor for being SV and for suffering psychological consequences.

Association between antibiotic pressure and the risk of colonization/infection by multidrug-resistant Acinetobacter baumannii complex: a time series analysis.

OBJECTIVE: To analyze the association between antibiotic pressure and the risk of colonization/infection by Acinetobacter baumannii complex (AB), evaluating both the individual and general prescriptions of antibiotics. METHODS: This is an analytical, observational, case-control study on patients admitted to an Intensive Care Unit (ICU) during an AB outbreak (14 months). A five-year time series was constructed with the monthly incidence of cases of infection/colonization with strains of AB resistant to each antibiotic administered and with the monthly consumption of these antibiotics in the ICU. RESULTS: We identified 40 patients either infected (23) or colonized (17) by AB and 73 controls. We found an epidemic multidrug-resistant clone of AB in 75% of cases. Risk factors associated with the development of AB infection/colonization were: greater use of medical instruments, the presence of a tracheostomy, cutaneous ulcers, surgical lesions and prior antibiotic therapies. The regression analysis of individual use of antibiotics showed that prior treatment with ceftazidime, ceftriaxone, amoxicillin/clavulanate, imipenem, levofloxacin, linezolid, and vancomycin was a risk factor for acquiring AB. ARIMA models showed that the relationship were greatest and statistically significant when the treatment occurred between 6 months (ceftazidime) and 9 months (imipenem and levofloxacin) prior. CONCLUSIONS: The dynamic and aggregate relationship between the incidence of infection/colonization by multidrug-resistant strains of AB and prior antibiotic treatment was statistically significant for intervals of 6 to 9 months.

Prevalencia de exceso ponderal entre los escolares de La Mancha-Centro según diferentes criterios / Excess weight in La Mancha-Centro schoolchildren by different criteria

INTRODUCCIÓN: La sobrecarga ponderal infantil constituye un importante problema de salud pública mundial. El índice de masa corporal (IMC) es el indicador más empleado. No existe acuerdo internacional sobre los criterios definitorios que se deben emplear en la infancia, lo que ocasiona gran variabilidad de cifras y dificulta su interpretación. OBJETIVO: Estimar la prevalencia de sobrepeso y obesidad de la población escolar del Área Sanitaria de La Mancha-Centro (Comunidad Autónoma de Castilla-La Mancha) aplicando diferentes criterios definitorios y valorar las diferencias encontradas. MATERIAL Y MÉTODOS: Estudio de corte transversal de una muestra representativa de 954 niños de 6 a 12 años. Se calculó la prevalencia de sobrepeso, obesidad y sobrecarga ponderal global, por sexo e intervalo anual, aplicando los criterios más empleados, nacionales (Estudio Transversal Español de Crecimiento 2010 -ETEC 2010-, Orbegozo 1988, Orbegozo 2004) e internacionales (Organización Mundial de la Salud - OMS-, International Obesity Task Force -IOTF-). RESULTADOS: La prevalencia global de sobrepeso, obesidad y sobrecarga ponderal fue, respectivamente, 25,4%, 21,1%, 46,5% con el criterio de OMS; 26,3%, 11,5%, 37,8% con IOTF; 9,8%, 14,8%, 24,6% con Orbegozo 1988; 10,9%, 15,4%, 26,3% con Orbegozo 2004; y 15,5%, 8,6%, 24,1% con ETEC 2010. Las mujeres presentaron prevalencias más elevadas de sobrepeso y obesidad que los varones, observándose diferencias estadísticamente significativas en la sobrecarga ponderal con todos los criterios empleados. CONCLUSIONES: Los escolares de La Mancha-Centro presentan prevalencias globales muy elevadas de sobrepeso, obesidad y sobrecarga ponderal, ampliamente variables según el criterio utilizado. Estas cifras son superiores a las de la mayoría de los últimos estudios españoles, nacionales o regionales, y de muchos países de nuestro entorno. Las mujeres muestran valores significativamente más altos que los varones. Sería recomendable unificar a nivel internacional qué puntos de corte utilizar en los estudios de exceso ponderal infantil

INTRODUCTION: Childhood excess weight is an important public health worldwide problem nowadays. Body Mass Index (BMI) is the most used indicator to estimate it. There is no international agreement on the defining criteria to be used in children, which implies great data variability and hinders its interpretation. OBJECTIVE: To estimate the prevalence of overweight and obesity in the schoolchildren of "La Mancha-Centro" Health Area (Castilla-La Mancha, Spain) applying different criteria and to assess the differences found. METHODS: Cross-sectional study of a representative sample of 954 from 6 to 12 years old schoolchildren. Overweight, obesity and excess weight prevalence was calculated by sex and age ranges, applying the most used national (Spanish CrossSectional Growth Study 2010 -SCGS 2010-, Orbegozo 1988, Orbegozo 2004) and international (World Health Organization - WHO-, International Obesity Task Force -IOTF-) criteria. RESULTS: Global prevalence of overweight, obesity and excess weight was, respectively, 25,4%, 21,1%, 46,5% with the WHO criteria; 26,3%, 11,5%, 37,8% following IOTF; 9,8%, 14,8%, 24,6% with Orbegozo 1988; 10,9%, 15,4%, 26,3% according to Orbegozo 2004; and 15,5%, 8,6%, 24,1% with SCGS 2010 cut-offs. Overweight and obesity prevalence was higher in girls than in boys, with significant differences in excess weight by all criteria. CONCLUSIONS: Schoolchildren in La Mancha-Centro display high global prevalence of overweight, obesity and excess weight, which varies a lot according to the applied standard and exceeds prevalence of last Spanish, national or regional, and European studies. Girls achieve higher levels than boys significantly. It would be advisable to unify internationally which cut-off points to use in child excess weight studies

Validación de la capacidad predictiva de resultado de parto del índice de Bishop y Burnett modificado por paridad / Predictive validity of Bishop and Burnett Scores for vaginal deliverymodified by parity

Fundamento: Validar la capacidad predictiva del resultado de parto de los índices Bishop (BS) y Burnett (BRS) frente a versiones modificadas en las que se incorpora la paridad (BSM y BRSM). Método: Cohortes históricas sobre un total de 728 inducciones realizadas durante los años 2011-2013 en el Hospital «La Mancha-Centro» (HLMC) de Alcázar de San Juan. Se evaluaron las características predictivas (análisis de validez interna) mediante áreas bajo la curva (ABC) ROC de cada parámetro de los BS y BRS y de la paridad, así como de cada uno de los 4 índices. Resultados: La paridad y todos los parámetros del BS y BRS, a excepción de la estación fetal y la posición del cuello, se asociaron con el resultado de parto. Se definieron dos nuevas escalas modificadas a partir del BS y BRS, previa eliminación del parámetro de la estación fetal, por ser el que menor capacidad discriminativa mostraba: BSM y BRSM. Se asignó un valor de 0 en las nulíparas y, en el caso de las multíparas, 3 puntos a BSM y 2 a BRSM. Los índices modificados mostraron una capacidad predictiva (ABC) de parto vaginal superior a la de los índices originales, tanto para BS (0,70 vs. 0,62) como para BRS (0,69 vs. 0,62). Conclusión: Los índices modificados BSM y BRSM, donde se sustituye el parámetro altura de la presentación por la paridad, presentan mejor capacidad predictiva respecto de los índices originales BS y BRS para determinar el resultado de parto (AU)

Background: Validating the predictive capacity on the outcome of labour of the Bishop Score (BS) and the simplified Burnett Score (BRS) compared to their modified versions, in which parity is incorporated. Methods: Historical cohorts out of a total of 728 inductions during the years 2012-2013 in the «La Mancha-Centro» Hospital of Alcázar de San Juan. We evaluated the predictive characteristics by areas under the (AUC) ROC curve for each parameter of BS and BRS and for parity, as well as for each of the 4 indices. Results: Parity and all the parameters of BS and BRS, except for foetal station and cervical position, were associated with the outcome of labour. Two modified scales were defined on the basis of BS and BRS, following removal of the "foetal station" parameter due to its low discriminative capacity: BSM and BRSM. Nulliparity was given a value of 0 points, and multiparity a value of 3 points for BSM, and 2 for BRSM. Modified indices showed a higher predictive ability (AUC) for vaginal delivery than the original indices, for both BS (0.70 vs. 0.62) and for BRS (0.69 vs. 0.62). Conclusion: Replacing the «foetal station» parameter with parity in BS and BRS, improves predictive capacity with regard to the original indices in order to determine the outcome of labour (AU)

[Predictive validity of Bishop and Burnett Scores for vaginal delivery modified by parity]. / Validación de la capacidad predictiva de resultado de parto del índice de Bishop y Burnett modificado por paridad.

BACKGROUND: Validating the predictive capacity on the outcome of labour of the Bishop Score (BS) and the simplified Burnett Score (BRS) compared to their modified versions, in which parity is incorporated. METHODS: Historical cohorts out of a total of 728 inductions during the years 2012-2013 in the "La Mancha-Centro" Hospital of Alcázar de San Juan. We evaluated the predictive characteristics by areas under the (AUC) ROC curve for each parameter of BS and BRS and for parity, as well as for each of the 4 indices. RESULTS: Parity and all the parameters of BS and BRS, except for foetal station and cervical position, were associated with the outcome of labour. Two modified scales were defined on the basis of BS and BRS, following removal of the "foetal station" parameter due to its low discriminative capacity: BSM and BRSM. Nulliparity was given a value of 0 points, and multiparity a value of 3 points for BSM, and 2 for BRSM. Modified indices showed a higher predictive ability (AUC) for vaginal delivery than the original indices, for both BS (0.70 vs. 0.62) and for BRS (0.69 vs. 0.62). CONCLUSION: Replacing the "foetal station" parameter with parity in BS and BRS, improves predictive capacity with regard to the original indices in order to determine the outcome of labour. Key Words. Bishop Score. Induction of labour. Outcome of labour. Parity. Predictive model.

Impact of self-financed rotavirus vaccines on hospital stays and costs in Spain after a 3-year introductory period.

Vaccination has reduced rotavirus hospitalizations by 25% in European regions with low-moderate vaccine availability. We aimed to quantify the reduction in hospital costs after the longest period in which Rotarix® and Rotateq® were simultaneously commercially available in Spain. Cases, length of stay (LOS), and diagnosis-related groups (DRGs) were retrieved from the Minimum Basic Data Set. Healthcare expenditure was estimated through the cost accounting system Gescot®. DRGs were clustered: I, non-bacterial gastroenteritis with complications; II, without complications; III, requiring surgical/other procedures or neonatal cases (highest DRG weights). Comparisons between pre (2003-2005)- and post-vaccine (2007-2009) hospital stays and costs by DRG group were made. Rotaviruses were the most common agents of specific-coded gastroenteritis (N = 1657/5012). LOS and extended LOS of rotaviruses fell significantly in 2007-2009 (ß-coefficient = -0·43, 95% confidence intervals (95% CI) -0·68 to -0·17; and odds ratio 0·62, 95% CI 0·50-0·76, respectively). Overall, costs attributable to rotavirus hospitalizations fell approximately €244 per patient (95% CI -365 to -123); the decrease in DRG group III was €2269 per patient (95% CI -4098 to -380). We concluded modest savings in hospital costs, largely attributable to cases with higher DRG weights, and a faster recovery. A universal rotavirus vaccination program deserves being re-evaluated, regarding its potential high impact on both at-risk children and societal costs.

A multifactorial regression analysis of the features of community-acquired rotavirus requiring hospitalization in Spain as represented in the Minimum Basic Data Set.

Over 10% of acute rotavirus gastroenteritis (ARGE) requires hospitalization because of complications. The aggravating factors have been widely analysed, but in an isolated way. We aimed to explore the interrelationship between the clinical and epidemiological factors that characterize rotavirus hospitalizations in Spain using information from the Minimum Basic Data Set (MBDS). Using ICD-9-CM codes, we classified acute gastroenteritis (AGE) cases by principal diagnosis fields and then categorized their comorbidities, complications, and epidemiological features by secondary fields. A multivariable, logistic, step-wise regression model was then constructed. We identified 1657 ARGE cases from 17 415 cases of AGE. Rotavirus hospitalizations were associated with place of residence, age, and season (P < 0·0001), as well as with dehydration [odds ratio (OR) 12·44, 95% confidence interval (CI) 1·52-40·38], intravenous rehydration (OR 1·74, 95% CI 1·29-2·35), metabolic acidosis (OR 1·51, 95% CI 1·24-1·83), respiratory tract infections (RTIs) (OR 1·60, 95% CI 1·09-1·98), and concomitant AGE (OR 1·52, 95% CI 1·03-2·25). Dehydration was four times more likely in patients aged <5 years (OR 4·36, 95% CI 1·20-12·96) and was associated with acidosis when ARGE and RTI were present simultaneously (P < 0·0001). Specific co-infecting viruses may play a role in acute respiratory symptoms and aggravation of gastrointestinal manifestations of rotaviruses, thus leading to complications requiring hospitalization.

Patrón dietético de la población escolar del Área La Mancha-Centro (Ciudad Real) / Food habits of the school population from La Mancha-Centro Health Area (Ciudad Real)

OBJETIVO: Valorar el patrón dietético de la población escolar del Área de Salud La Mancha Centro (Ciudad Real). METODOLOGÍA: Estudio transversal sobre una muestra representativa de los escolares de 6 a 12 años. Se utilizó un cuestionario para explorar los hábitos dietéticos generales y un recordatorio de ingesta de 24 h. RESULTADOS: Se evaluó a 1.142 escolares, 612 niños (53,6%) y 530 niñas (46,4%), con una edad de 9,3±1,7 años. La frecuencia de la ingesta de alimentos, de 4,62±0,6 veces al día, decrecía de forma estadísticamente significativa con la edad de los escolares (p = 0,044) y aumentaba con el nivel educativo de los padres (p = 0,004). La preferencia era un factor influyente en la elección de los alimentos consumidos. El grado de apetito se relacionó de forma directa con el peso y el índice de masa corporal (p< 0,001), la edad (p = 0,02) y el número de ingestas diarias (p = 0,038). Los grupos de alimentos más frecuentemente ingeridos fueron los cereales y derivados (92,8%), la leche y derivados (90,45%) y los menos, las verduras y hortalizas (35,46%). Más del 70% de la muestra consumía como aceite habitual el de oliva. CONCLUSIÓN: El patrón dietético de los escolares mantiene algunas de las características del patrón de dieta mediterránea tradicional, como el hábito de desayuno, el elevado consumo de aceite de oliva o de cereales, pero no otras, destacando el escaso consumo de verduras y frutas, y el elevado de carnes

OBJECTIVE: To assess the dietary pattern of the school population from La Mancha-Centro Health Area (Ciudad Real). METHODOLOGY: A cross-sectional study conducted on a representative sample of schoolchildren aged 6 to 12 years, using a questionnaire to determine their general dietary habits and a record of their 24-hour intake. RESULTS: A total of 1142 schoolchildren were included, with 612 boys (53.6%) and 530 girls (46.4%), and a mean age of 9.3±1.7 years of age. The frequency of food intake was 4.62±0.6 times a day, which decreased with the age of the schoolchildren (P=.044), and increased with the educational level of parents (P=.004). Food preference influenced the choice in the meals consumed. The level of appetite was related directly with weight and body mass index (BMI)(P<.001), age (P=.02), and number of daily food intakes by the children (P=.038). The food groups most frequently consumed were cereals and their derivatives (92.8%), milk and dairy products (90.45%), while vegetables were the least consumed (35.46%). Over 70% of the sample usually consumed olive oil. CONCLUSION: The dietary pattern of the school population maintains some of the features of traditional Mediterranean dietary pattern, such as the habit of daily breakfast, the greater consumption of olive oil and cereals. On the other hand, other characteristics are remarkable, such as the low consumption of fruit and vegetables and the high consumption of meat

[Food habits of the school population from La Mancha-Centro Health Area (Ciudad Real)]. / Patrón dietético de la población escolar del Área La Mancha-Centro (Ciudad Real).

OBJECTIVE: To assess the dietary pattern of the school population from La Mancha-Centro Health Area (Ciudad Real). METHODOLOGY: A cross-sectional study conducted on a representative sample of schoolchildren aged 6 to 12 years, using a questionnaire to determine their general dietary habits and a record of their 24-hour intake. RESULTS: A total of 1142 schoolchildren were included, with 612 boys (53.6%) and 530 girls (46.4%), and a mean age of 9.3 ± 1.7 years of age. The frequency of food intake was 4.62 ± 0.6 times a day, which decreased with the age of the schoolchildren (P=.044), and increased with the educational level of parents (P=.004). Food preference influenced the choice in the meals consumed. The level of appetite was related directly with weight and body mass index (BMI) (P<.001), age (P=.02), and number of daily food intakes by the children (P=.038). The food groups most frequently consumed were cereals and their derivatives (92.8%), milk and dairy products (90.45%), while vegetables were the least consumed (35.46%). Over 70% of the sample usually consumed olive oil. CONCLUSION: The dietary pattern of the school population maintains some of the features of traditional Mediterranean dietary pattern, such as the habit of daily breakfast, the greater consumption of olive oil and cereals. On the other hand, other characteristics are remarkable, such as the low consumption of fruit and vegetables and the high consumption of meat.

Seasonal distribution of initial diagnosis and clinical recrudescence of eosinophilic esophagitis: a systematic review and meta-analysis.

BACKGROUND: The association between seasonality and diagnosis and/or recrudescence of eosinophilic esophagitis (EoE) remains unclear, with some studies demonstrating a higher diagnostic rate in those months with a higher aeroallergen load while others rule out this association. METHODS: We performed a systematic search of the MEDLINE, EMBASE, and SCOPUS databases for studies on the seasonality of the initial diagnosis or recrudescence (i.e., food bolus impaction) of EoE. Summary estimates, including 95% confidence intervals, were calculated for seasonal variation in diagnosis or incidence of food bolus impaction. A random-effects meta-regression model was made using aggregate-level data to compare seasonality in EoE diagnosis and recrudescence. Publication bias risks were assessed by means of funnel plot analysis. RESULTS: Of 1078 references found, data were finally collected from 18 studies which included a total of 16,846 EoE patients. Of all new cases of EoE diagnosed per year, 27.1% were diagnosed in spring and 21.5% in winter. No overall statistical differences in the annual seasonal distribution of newly diagnosed EoE cases were observed in the random-effects meta-regression model (P = 0.132). Similarly, a homogenous distribution of episodes of EoE recrudescence throughout the year was noted, with no significant differences between seasons (P = 0.699). No significant publication bias was found. CONCLUSIONS: This systematic review found no significant variations in the seasonal distribution of either the diagnosis or clinical recrudescence of EoE throughout the year.