[Sociodemographic characteristics and risk factors associated to significative bacteriuria in a Spanish health area]. / Características sociodemográficas y factores de riesgo asociados a las bacteriurias significativas en un área de salud del sudeste español.

OBJECTIVE: To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship with sociodemographic factors and to analyze risk factors in inpatients. METHODS: Cross-sectional descriptive study carried out on urine culture samples received between 2016-2020 in the Microbiology laboratory, differentiating between minors and adults. The dependent variable was the presence of SB and the independent variables were age, sex, year, type of sample and source of the sample. In urine cultures of inpatients, risk factors were evaluated from the Minimum Basic Data Set. RESULTS: A total of 68,587 valid records (96.3% of the total) were analyzed. 40.8% (95% CI: 40.4%-41.2%) of urine cultures in adults and 33.8% (95% CI: 32.9%-34.7%) in children were positive, with an incidence that ranged in adults between 18.2 cases/1,000 inhabitants in 2016 and 14.6 cases/1,000 inhabitants in 2020 and 21.1 and 8.4 cases/1,000 inhabitants respectively in minors. Positive urine cultures were more frequent in children from urban areas compared to rural areas (OR=1.37; p<0.01). In hospitalized adults, for each year of age the risk of SB increased by 2%, it was 36% higher in women, 18% higher in obese patients and 17% more frequent in patients with kidney disease, (p<0.01). No relationship was observed between SB and diagnosis of COVID-19. CONCLUSIONS: The sociodemographic characteristics of the population with SB in our health area are similar to those found in other geographical areas worldwide, observing a decreasing trend in incidence in the years studied. The frequency of SB in children is higher in urban areas.

Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia.

Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.

[Patterns of rare congenital diseases in patients admitted to a regional hospital]. / Patrones de las enfermedades raras congénitas en pacientes ingresados en un hospital regional.

BACKGROUND: To describe the pattern of patients admitted due to rare diseases corresponding to congenital anomalies in a regional hospital. METHODS: Retrospective transversal study. We considered hospital discharges for the years 2009-2012 with principal diagnosis between codes CIE 9R MC 740-759. The source of information was the Basic Minimum Data Set. Socio-demographic and clinical variables were analyzed. RESULTS: One point six percent (1.6%) of the population was admitted to hospital due to rare congenital diseases. Fifty-eight point five percent (58.5%) were male, with average age 21.4 ± 21.5 years. The major diagnostic categories were: diseases of the nervous system (86.9%), circulatory systems diseases (51.7%) and musculoskeletal system diseases (50.3%). Eighteen percent (18%) of hospital admissions corresponded to patient readmissions. The service with the greatest number of episodes was Pediatric Surgery, 29%, followed by Neurosurgery, 20%. CONCLUSIONS: The pattern of rare congenital disease in the "Virgen de Nieves" University Hospital corresponds to a young patient, with a disease belonging to the diseases of the nervous system group of the major diagnostic categories, treated surgically, and with a low percentage of readmissions.

Patrones de las enfermedades raras congénitas en pacientes ingresados en un hospital regional / Patterns of rare congenital diseases in patients admitted to a regional hospital

Fundamento. Describir el patrón de pacientes ingresados por enfermedades raras correspondientes a anomalías congénitas en un hospital regional. Métodos. Estudio transversal retrospectivo. Se consideraron las altas de hospitalización de los años 2009-2012 con diagnóstico principal entre los códigos CIE 9RMC 740-759. La fuente de información fue el Conjunto Mínimo Básico de Datos. Se analizaron variables sociodemográficas y clínicas. Resultados. Ingresan en el hospital por enfermedades raras congénitas un 1,6% de la población Un 58,5% fueron varones, con edad media de 21,4 ± 21,5 años. Las Categorías Diagnósticas Mayores más frecuentes fueron Enfermedades del sistema nervioso (86,9%), Enfermedades del aparato circulatorio (51,7%) y Sistema músculo-esquelético (50,3%). El 18% de las hospitalizaciones correspondieron a reingresos de pacientes. El servicio con mayor número de episodios fue Cirugía Pediátrica, 29%, seguido de Neurocirugía, 20%. Conclusiones. El patrón de enfermedad rara congénita en el hospital Universitario Virgen de las Nieves corresponde a un paciente joven, con una enfermedad perteneciente al grupo de la Categoría Diagnóstica Mayor Enfermedad del sistema nervioso tratada quirúrgicamente y un porcentaje de reingresos no elevado (AU)

Background. To describe the pattern of patients admitted due to rare diseases corresponding to congenital anomalies in a regional hospital. Methods. Retrospective transversal study. We considered hospital discharges for the years 2009-2012 with principal diagnosis between codes CIE 9R MC 740-759.The source of information was the Basic Minimum Data Set. Socio-demographic and clinical variables were analyzed. Results. One point six percent (1.6%) of the population was admitted to hospital due to rare congenital diseases. Fifty-eight point five percent (58.5%) were male, with average age 21.4 ± 21.5 years. The major diagnostic categories were: diseases of the nervous system (86.9%), circulatory systems diseases (51.7%) and musculoskeletal system diseases (50.3%). Eighteen percent (18%) of hospital admissions corresponded to patient readmissions. The service with the greatest number of episodes was Pediatric Surgery, 29%, followed by Neurosurgery, 20%. Conclusions. The pattern of rare congenital disease in the “Virgen de Nieves” University Hospital corresponds to a young patient, with a disease belonging to the diseases of the nervous system group of the major diagnostic categories, treated surgically, and with a low percentage of readmissions (AU)

Factores asociados al abandono del tratamiento de la tuberculosis en la provincia de Granada / Factors associated to dropout of tuberculostatic treatment in the province of Granada

Objetivos. Los factores asociados al abandono del tratamiento de la tuberculosis (TBC) pueden ser muy específicos de la población y de la organización sanitaria locales. Hemos examinado los factores asociados al abandono del tratamiento de la TBC en la provincia de Granada. Sujetos y métodos. Cohorte retrospectiva de los casos registrados en Granada y notificados en el Sistema de Vigilancia Epidemiológica de Andalucía durante los años 2003-2010. Se calculó la incidencia en la población nacional y extranjera. Se realizó un análisis univariante para describir las características en ambos colectivos y se creó un modelo de regresión logística para identificar los factores asociados al abandono terapéutico. Resultados. Observamos una tendencia decreciente en la incidencia de TBC (20,47 casos en el año 2007 y 11,00 en el 2010 por 100.000 habitantes; tasa de descenso de 9,47 casos por 100.000 habitantes). La edad media de los pacientes extranjeros fue menor que la de los enfermos nacionales (30,8 años vs 46,0 años; p<0,001). Los primeros residían de forma predominante en el distrito Granada, mientras que los nacionales habitaban en el distrito Metropolitano. El porcentaje de pacientes que abandonaron el tratamiento antituberculoso fue del 12,2% y fue algo superior en los enfermos extranjeros que entre los nacionales (14 vs 10%; p=0,062). Ser varón (OR: 1,65; IC del 95%: 1,04-2,60; p=0,033), extranjero (OR: 1,72; IC del 95%: 1,04-2,83; p=0,032), residente en el distrito Nordeste (OR: 3,64; IC del 95%: 1,76-7,52; p=0,005) y/o padecer TBC extrapulmonar (OR: 1,78; IC del 95%: 1,06-3,00; p=0,029) se asociaron de forma significativa con el abandono terapéutico. Conclusiones. La incidencia de TBC en la provincia de Granada se ha reducido alrededor de 10 casos por 100.000 habitantes y año. El porcentaje de enfermos que abandonan el tratamiento TBC es considerable, siendo superior en los pacientes extranjeros que en los nacionales. El abandono del tratamiento TBC se asoció a ser varón, residir en el distrito Nordeste de Granada y padecer TBC extrapulmonar(AU)

Objectives. The factors associated to tuberculosis (TB) treatment drop-out can be very specific to the population and the local health care organization. We have studied the factors associated to TB treatment drop out in the province of Granada. Subjects and methods. A retrospective cohort study of TB cases registered in the province of Granada by the Epidemiological Surveillance System of Andalusia (SVEA) between 2003 and 2010 was carried out. Incidence was calculated in the native and foreign population. An univariate analysis was performed to describe the characteristics in both groups and a logistic regression model was used to identify factors associated to therapeutic abandonment. Results. A decreasing trend in the incidence of TB was observed, (20.47 in 2007 to 11 cases per 100,000 inhabitants in 2010, respectively. Mean age of foreign patients was lower than that of the natives (30.8 years vs. 46.0 years, P<.001). The former predominately lived in the Granada district, while the natives lived in the Metropolitan district. The percentage of patients who abandoned antituberculous treatment was 12.2%, this being somewhat higher in the foreign patients than the national ones (14% vs 10%; P=.062). Being male (OR: 1.65; 95% CI: 1.04-2.60; P=.033), foreigner (OR: 1.72; 95% CI: 1.04-2.83; P=.032), resident in the North-east district (OR: 3.64; 95% CI: 1.76-7.52; P=.005) and/or having extrapulmonary TB (OR: 1.78; 95% CI: 1.06-3.00; P=.029) were associated significantly to therapeutic abandonment. Conclusions. The incidence of TB in the province of Granada has decreased to about 10 cases per 100,000 inhabitants/year. The percentage of patients who abandon TB treatment is significant, it being higher in foreign patients than in the natives. TB treatment abandonment was associated to being a man, living in the North-east district of Granada and having extrapulmonary TB(AU)

[Factors associated to dropout of tuberculostatic treatment in the province of Granada]. / Factores asociados al abandono del tratamiento de la tuberculosis en la provincia de Granada.

OBJECTIVES: The factors associated to tuberculosis (TB) treatment drop-out can be very specific to the population and the local health care organization. We have studied the factors associated to TB treatment drop out in the province of Granada. SUBJECTS AND METHODS: A retrospective cohort study of TB cases registered in the province of Granada by the Epidemiological Surveillance System of Andalusia (SVEA) between 2003 and 2010 was carried out. Incidence was calculated in the native and foreign population. An univariate analysis was performed to describe the characteristics in both groups and a logistic regression model was used to identify factors associated to therapeutic abandonment. RESULTS: A decreasing trend in the incidence of TB was observed, (20.47 in 2007 to 11 cases per 100,000 inhabitants in 2010, respectively. Mean age of foreign patients was lower than that of the natives (30.8 years vs. 46.0 years, P<.001). The former predominately lived in the Granada district, while the natives lived in the Metropolitan district. The percentage of patients who abandoned antituberculous treatment was 12.2%, this being somewhat higher in the foreign patients than the national ones (14% vs 10%; P=.062). Being male (OR: 1.65; 95% CI: 1.04-2.60; P=.033), foreigner (OR: 1.72; 95% CI: 1.04-2.83; P=.032), resident in the North-east district (OR: 3.64; 95% CI: 1.76-7.52; P=.005) and/or having extrapulmonary TB (OR: 1.78; 95% CI: 1.06-3.00; P=.029) were associated significantly to therapeutic abandonment. CONCLUSIONS: The incidence of TB in the province of Granada has decreased to about 10 cases per 100,000 inhabitants/year. The percentage of patients who abandon TB treatment is significant, it being higher in foreign patients than in the natives. TB treatment abandonment was associated to being a man, living in the North-east district of Granada and having extrapulmonary TB.

Survival analysis and Cox regression

The data provided by clinical trials are often expressed in terms of survival. The analysis of survival comprises a series of statistical analytical techniques in which the measurements analysed represent the time elapsed between a given exposure and the outcome of a certain event. Despite the name of these techniques, the outcome in question does not necessarily have to be either survival or death, and may be healing versus no healing, relief versus pain, complication versus no complication, relapse versus no relapse, etc.The present article describes the analysis of survival from both a descriptive perspective, based on the Kaplan–Meier estimation method, and in terms of bivariate comparisons using the log-rank statistic. Likewise, a description is provided of the Cox regression models for the study of risk factors or covariables associated to the probability of survival. These models are defined in both simple and multiple forms, and a description is provided of how they are calculated and how the postulates for application are checked – accompanied by illustrating examples with the shareware application R(AU)

Survival analysis and Cox regression.

The data provided by clinical trials are often expressed in terms of survival. The analysis of survival comprises a series of statistical analytical techniques in which the measurements analysed represent the time elapsed between a given exposure and the outcome of a certain event. Despite the name of these techniques, the outcome in question does not necessarily have to be either survival or death, and may be healing versus no healing, relief versus pain, complication versus no complication, relapse versus no relapse, etc. The present article describes the analysis of survival from both a descriptive perspective, based on the Kaplan-Meier estimation method, and in terms of bivariate comparisons using the log-rank statistic. Likewise, a description is provided of the Cox regression models for the study of risk factors or covariables associated to the probability of survival. These models are defined in both simple and multiple forms, and a description is provided of how they are calculated and how the postulates for application are checked - accompanied by illustrating examples with the shareware application R.

Simple linear and multivariate regression models

In biomedical research it is common to find problems in which we wish to relate a response variable to one or more variables capable of describing the behaviour of the former variable by means of mathematical models. Regression techniques are used to this effect, in which an equation is determined relating the two variables. While such equations can have different forms, linear equations are the most widely used form and are easy to interpret. The present article describes simple and multiple linear regression models, how they are calculated, and how their applicability assumptions are checked. Illustrative examples are provided, based on the use of the freely accessible R program (AU)

Simple linear and multivariate regression models.

In biomedical research it is common to find problems in which we wish to relate a response variable to one or more variables capable of describing the behaviour of the former variable by means of mathematical models. Regression techniques are used to this effect, in which an equation is determined relating the two variables. While such equations can have different forms, linear equations are the most widely used form and are easy to interpret. The present article describes simple and multiple linear regression models, how they are calculated, and how their applicability assumptions are checked. Illustrative examples are provided, based on the use of the freely accessible R program.

Design and debugging databases for statistical analysis.

Any form of data analysis requires the prior creation of a database to house the study information collected in one format or other (questionnaire, clinical history, etc.). The design of such databases should be optimised to allow adequate statistical analysis without the drawing of wrong conclusions. In addition, prior to analysis, debugging or filtering of the variables is required in order to avoid doubling the effort made in extracting the results. The present study offers a series of suggestions for database design and debugging, to ensure that the later statistical analyses are based on the revised data.

Design and debugging databases for statistical analysis

Any form of data analysis requires the prior creation of a database to house the study information collected in one format or other (questionnaire, clinical history, etc.). The design of such databases should be optimised to allow adequate statistical analysis without the drawing of wrong conclusions. In addition, prior to analysis, debugging or filtering of the variables is required in order to avoid doubling the effort made in extracting the results. The present study offers a series of suggestions for database design and debugging, to ensure that the later statistical analyses are based on the revised data (AU)

No disponible

[Nursing professionals' reading habits; a study in a hospital in Granada]. / Hábitos de lectura en enfermería: estudio en un hospital de granada.

In all the hospital library standards, as well as in the existing Accreditation Norms for hospitals, a section is included which cites the distinct professionals who work at the institution which the library services must attend to provide for their scientific information needs. Among the sanitary collectives, nursing professionals are explicitly listed. Nonetheless, since the creation of hospital library services in Spain, many librarians have noticed that the nursing professionals, which compose the most numerous group in a hospital, have a very low library visitation rate in relationship to other collectives such as doctors in particular. Desiring to have objective data regarding library use, and not merely perceptions, the authors planned out a study in a large, 1.200 bed, hospital where more than 1.000 professionals comprise the nursing staff. The authors wanted to verify the nursing staff's needs for scientific information, their habits regarding their scientific information needs, and the possible difficulties which they encounter trying to acquire this type of information; furthermore, the authors wanted to know the nursing professionals' attitude towards this issue.

Hábitos de lectura en Enfermería. Estudio en un hospital de Granada / Nursing professionals´ reading habits; a study in a hospital in Granada

En todos los estándares de bibliotecas de hospital, asf como en las Normas de Acreditación de hospitales existentes, figura un apartado en el que se citan los distintos profesionales de la institución a los que hay que atender en sus necesidades de información cientffica. Entre los colectivos sanitarios figura explfcitamente el de enfermería. Sin embargo, muchos bibliotecarios perciben desde la creación de las bibliotecas hospitalarias en España que, con relación a otros colectivos (el de médicos en concreto), el personal de enfermería, siendo el más numeroso en el hospital, tiene una incidencia de visitas ala biblioteca muy baja. Queriendo tener datos objetivos al respecto, yno simples percepciones, se ha planteado un estudio en un gran hospital (1.200 camas) donde el colectivo de enfermerfa está compuesto por mas de 1.000 profesionales. Hemos querido averiguar sus necesidades de información cientffica, sus hábitos al respecto, y las posibles dificultades que pudieran tener en la consecución de este tipo de información, asf como su actitud en este tema

In all the hospitallibrarystandards, as well as in the existing Accreditation Norms for hospitals, a section is included which cites the distinct professionals who work at the institution which the library services must attend to provide for their scientific informarían needs. Amongthe sanitary collectives, nursing professionals are explicitly listed. Nonetheless, since the crearían of hospital librar y services in Spain, many librarians have noticed that the nursing professionals, which composethe most numerous group inahospital, ha ve a very low librar y visitarían rafe in relationship to other collectives such as doctors in particular. Desiring to have objective data regarding library use, and not merely perceptions, theauthors planned out a study in a large, 1.200 bed, hospital wheremore than 1.000 professionals comprise the nursing staff. The authors wanted to verify the nursing staff's needs for scientific information, their habits regarding their scientific information needs, and the possible difficulties which they encounter trying to acquire this type of informartion; furthermore, the authors wanted to know the nursing professionals' attitude towards this issue

[Organizational characteristics of primary care and hospitalization for to the main ambulatory care sensitive conditions]. / Características organizativas de la atención primaria y hospitalización por los principales ambulatory care sensitive conditions.

OBJECTIVES: To describe the variability in hospitalisation rates because of the most common ambulatory care sensitive conditions (ACSC), by town and gender; b) to describe the influence on these rates of the characteristics of primary care (reformed or non-reformed model and kind of centre), the health level of the population, geographical accessibility and other factors of a social and economic nature. DESIGN: Observational, cross-sectional study of hospital discharges and ecological study for the analysis of rates between towns. MAIN MEASUREMENTS: The rates of hospitalisation by gender for each ACSC (1997-1999), standardised for age through the indirect method by calculating the standardised rate ratios (SRR). The multivariate analysis used Poisson regression. RESULTS: In the diagnoses studied, 41% of the towns had the same number of cases observed and expected for hospitalisation of men; and 65%, for women. Chronic obstructive pulmonary disease in men and heart failure in women were the illnesses that most varied. Hospitalisation rates for most illnesses were higher in towns without a health centre or with a non-reformed model, with over 3000 inhabitants and closer to hospital, although distance from the hospital was an influential factor only in bigger towns. CONCLUSIONS: There is variability between towns in hospitalisation rates for the most common ACSC; b) the differences in hospitalisation rates for the ACSC studied are linked to organisational features of primary care, the size of the town and the distance from the hospital.

[Factors associated with hospitalization for ambulatory care sensitive conditions in municipalities]. / Factores asociados a la hospitalización por procesos sensibles a cuidados ambulatorios en los municipios.

OBJECTIVES: To describe variability in admission rates for ambulatory care sensitive conditions (ASSC) in municipalities in the catchment area of a tertiary hospital and to determine the influence of primary care characteristics, socioeconomic factors, health of the population, and geographical accessibility to the hospital on this variability. METHODS: An ecological study was carried out in 34 municipalities in the area served by the Hospital Virgen de las Nieves in Granada (Spain) including all admissions for ASSC from 1997 to 1999. The admission rates for men and women were calculated separately and were age-standardized by the indirect method. The following factors were analyzed as independent variables: characteristics of primary care (type of healthcare model and type of center), socioeconomic factors (unemployment rate, income per capita, number of business establishments, size of municipality), health (mortality rate), and accessibility (time in minutes from the municipality to the hospital). A multiple lineal regression model was estimated. RESULTS: A total of 9.8% of all hospital admissions were due to ASSC. The mean annual admission rate was 10 admissions per 1.000 inhabitants. This rate was higher for men and for persons aged more than 74 years. The standardized admission ratios were not statistically different from 1 in 56% of the municipalities and were higher than 1 in 26% and lower than 1 in 18%. Sixty-two percent of the variability in rates for men was associated with time taken to reach the hospital, size of municipality, the interaction between both variables, and mortality. Eighteen percent of the variability in rates for women was associated with time taken to reach the hospital and the unemployment rate. CONCLUSIONS: Variability in admission rates for ASSC was not associated with primary care characteristics in the geographical area analyzed. Accessibility (measured as time to the hospital) was the only variable associated with higher rates in both men and women. Admission rates for ASSC among women were higher when unemployment rates were higher, and rates among men were higher in larger municipalities and in those with higher mortality.

Factores asociados a la hospitalización por procesos sensibles a cuidados ambulatorios en los municipios / Hospitalization for ambulatory care sensitive conditions: analysis of related factors in municipalities

Objetivos: Describir la variabilidad en las tasas de hospitalización por procesos sensibles a cuidados ambulatorios (PSCA) entre municipios del área de referencia de un hospital de tercer nivel, y determinar la influencia de las características de la atención primaria, los factores socioeconómicos, el nivel de salud de la población y la accesibilidad geográfica al hospital. Método: Se realizó un estudio ecológico en 34 municipios del área del Hospital Virgen de las Nieves (Granada), abarcando todas las hospitalizaciones por PSCA de 1997 a 1999.Las tasas de hospitalización se calcularon por separado para varones y mujeres y se estandarizaron por el método indirecto según la edad. Se exploraron como variables independientes las siguientes: características de la atención primaria (tipo de modelo y centro), socioeconómicas (desempleo, renta, comercios, tamaño del municipio), de salud (mortalidad) y accesibilidad (crona: minutos desde el municipio al hospital). Se realizó un análisis de regresión lineal múltiple. Resultados: El 9,8 por ciento de los ingresos ocurridos en el hospital fueron por PSCA. La tasa media anual fue de 10 ingresos por 1.000 habitantes, siendo superior en varones y en los mayores de 74 años. En el 56 por ciento de los municipios las razones de hospitalización estandarizadas no fueron estadísticamente diferentes de 1, en un 26 por ciento fueron menores y en un 18 por ciento, mayores. Un 62 por ciento de la variabilidad en las tasas de los varones se explicó por la crona al hospital, el tamaño del municipio, la interacción entre ambas variables y la mortalidad. Las tasas en mujeres se explicaron en un 18 por ciento por la crona y la tasa de desempleo. Conclusiones: La variabilidad de las tasas de hospitalización por PSCA no se asoció a las características de la atención primaria en el ámbito geográfico estudiado. La mayor accesibilidad en tiempo al hospital fue la única variable asociada a mayores tasas en varones y mujeres. Las tasas en mujeres fueron superiores cuanto mayor era el desempleo, y las tasas en varones fueron más altas en los pueblos grandes y con mayor mortalidad.. (AU)