Acciones preventivo-curativas en la atención a la población / de 0 a 19 años / Preventive and curative actions in the care of a population aged / 0 to 19 years

RESUMEN Introducción: la salud bucal es parte integrante de la salud general; su deficiencia tiene importantes repercusiones, con consecuencias perjudiciales, en el crecimiento y desarrollo de niños y adolescentes. Su evaluación constituye una herramienta importante para la toma de decisiones y para aspirar a un servicio de excelencia. Objetivo: evaluar el cumplimiento de las acciones preventivo-curativas programadas para la atención a la población de 0 a 19 años en la Escuela «René Fraga¼. Métodos: se realizó un estudio descriptivo y transversal en la Facultad de Estomatología de la Universidad de Ciencias Médicas de Villa Clara, en el período de octubre de 2018 a abril de 2019; se revisaron 473 historias clínicas de alumnos matriculados en la Escuela «René Fraga¼, los cuales constituyeron la población de estudio. Resultados: se cumplimentaron las acciones de planificación y de promoción de salud; las acciones de prevención y las curativas fueron las más desfavorables, lo que aportó un resultado final de medianamente cumplidas las acciones evaluadas. Conclusiones: las acciones de planificación inicial y promoción alcanzaron la máxima categoría y otorgaron la mayor cantidad de puntos a la evaluación; las acciones preventivo-curativas desarrolladas en el programa analizado resultaron insuficientes, lo que concedió a la evaluación general una calificación de medianamente cumplida.

ABSTRACT Introduction: oral health is an integral part of general health; its deficiency has important repercussions, with harmful consequences, on the growth and development of children and adolescents. Its evaluation constitutes an important decision-making tool in order to aspire to an excellent service. Objective: to evaluate the fulfillment of the preventive and curative actions programmed for the care of the population aged 0 to 19 years at "René Fraga" School. Methods: a descriptive and cross-sectional study was carried out in the Dentistry Faculty from the University of Medical Sciences of Villa Clara, between October 2018 and April 2019; 473 medical records of students enrolled at "René Fraga" School were reviewed, which constituted the study population. Results: health planning and promotion actions were completed; the preventive and curative actions were the most unfavorable, which provided a final result of moderately fulfilled the evaluated actions. Conclusions: the initial planning and promotion actions reached the highest category and awarded the highest number of points to the evaluation; the preventive and curative actions developed in the analyzed program were insufficient, which gave to the general evaluation a qualification of moderately complete.

Efectividad de una demostración clínica simulada para elevar los conocimientos sobre RCP-B en el adulto / Effectiveness of a simulated clinical performance to raise the adults' knowledge about Bystander Cardiopulmonary Resuscitation

Introducción: La ejecución de maniobras de reanimación cardiopulmonar por las personas que han presenciado un paro aumenta siete veces las posibilidades de supervivencia. Objetivo: Evaluar la efectividad de una demostración de situación clínica simulada realizada en los domicilios para elevar el nivel de conocimientos sobre reanimación cardiopulmonar básica en el adulto. Métodos: Se realizó un estudio de tipo antes y después sin grupo control entre septiembre y diciembre de 2018. El universo estuvo conformado por 620 pacientes pertenecientes a un consultorio del policlínico 19 de abril de Plaza de la Revolución. Se seleccionó una muestra de 200 pacientes y se les aplicó una encuesta, realizada por los autores, antes y después de la intervención, la cual se sometió a test alfa para la validación interna. Para la evaluación de la demostración se utilizó la prueba t de student, un análisis de varianza (ANOVA) y un análisis post hoc. Resultados: La media de edad fue de 45,45 ± 14,45 años. El sexo femenino predominó con 102 personas (51 por ciento). Hubo 63 (32 por ciento) pacientes con nivel de técnico medio. La diferencia de las medias de puntos antes y después de la demostración fue estadísticamente significativa en todos los grados de escolaridad (p ˂ 0,001). Hubo diferencias en el aumento de puntos después de la demostración entre los universitarios y las personas con sexto grado (p = 0,013). Conclusiones: Realizar una demostración con una situación clínica simulada constituyó una herramienta efectiva para elevar el nivel de conocimiento de la población en estudio, independientemente del nivel de escolaridad(AU)

Introduction: Bystander cardiopulmonary resuscitation increases the chances of survival by seven times. Objective: To assess the effectiveness of a simulated clinical situation carried out in homes to raise the level of knowledge about basic cardiopulmonary resuscitation in adults. Methods: A before-and-after study without a control group was carried out between September and December 2018. The universe consisted of 620 patients from a family doctor's office belonging to 19 de Abril Outpatient Polyclinic in Plaza de la Revolución Municipality (Havana, Cuba). A sample of 200 patients was selected and a survey was applied on them, carried out by the authors, before and after the intervention, which was subjected to an alpha test for internal validation. For the assessment of the demonstration, Student's t test, variance analysis (ANOVA) and a post hoc analysis were used. Results: The mean age was 45.45 ± 14.45 years. The female sex predominated, with 102 people (51 percent). There were 63 (32 percent) patients with an associate's degree. The difference in the means of scores before and after the demonstration was statistically significant in all school levels (P˂0.001). There were differences in the increase of scores after the simulated performance between the university students and the people with sixth grade (P=0.013). Conclusions: Performance of a simulated clinical situation was an effective tool to raise the level of knowledge of the population under study, regardless of their level of education(AU)

Efectos del ejercicio físico en la prevención de caídas en pacientes con enfermedad de Alzheimer: revisión sistemática / Effects of physical exercise in the prevention of falls in patients with Alzheimer's disease: A systematic review

OBJETIVOS: Conocer los efectos del ejercicio físico en la prevención de caídas en personas con enfermedad de Alzheimer, y el tipo de ejercicio con mejor eficacia clínica. ESTRATEGIA DE BÚSQUEDA: Siguiendo la estrategia PICOS y las recomendaciones PRISMA, se llevó a cabo una revisión sistemática con búsqueda manual y electrónica en las bases de datos Pubmed, Scielo, PEDro, Biblioteca Cochrane, Web of Science, Medline, IBECS y LILACS. SELECCIÓN DE ESTUDIOS: Con criterios preestablecidos, se incluyeron estudios con al menos un grupo de tratamiento con ejercicio, publicados entre 2010 y 2018. De 278 registros iniciales, utilizando las herramientas de cribado de las diferentes bases de datos (cronología, tipo de estudio, etc.) se descartaron 217 artículos. Se realizó una evaluación mediante una lectura crítica de los 61 artículos que habían superado los filtros de búsqueda para identificar aquellos estudios que fueron susceptibles de incluirse en esta revisión sistemática. Finalmente, se incluyeron 9 artículos que dieron lugar a 5 estudios. SÍNTESIS DE RESULTADOS: La puntuación media en la escala PEDro de los 5 estudios es de 6,2. Todos los estudios han obtenido diferencias significativas a favor de los grupos que realizaron tratamiento mediante ejercicio físico. Los ejercicios individuales domiciliarios presentan mejores efectos que los ejercicios ambulatorios grupales. Los resultados favorables se obtienen a las 8 semanas de comenzar el tratamiento. CONCLUSIONES: Un programa de ejercicio físico que incluya entrenamiento de la fuerza, entrenamiento del equilibrio, ejercicios funcionales y marcha puede prevenir las caídas en pacientes con enfermedad de Alzheimer de forma factible y segura

OBJECTIVES: To know the effects of physical exercise in the prevention of falls in people with Alzheimer's disease and the type of exercise with better clinical efficacy. SEARCH STRATEGY: Following the PICOS strategy and PRISMA recommendations, a systematic review was carried out with manual and electronic search in the Pubmed, Scielo, PEDro, Cochrane Library, Web of Science, Medline, IBECS and LILACS databases. STUDY SELECTION: With pre-established criteria, studies with at least one treatment group with exercise, published between 2010 and 2018 are included. Of 278 initial records, using the screening tools of the different databases (chronology, type of study, etc.) 217 items were discarded. An evaluation was carried out through a critical reading of the 61 articles that had passed the search filters to identify the studies that were likely to be included in this systematic review. Finally, 9 articles that resulted in 5 studies were included. SYNTHESIS OF RESULTS: The average score on the PEDro scale of the 5 studies is 6.2. All studies included obtained significant differences in the groups treated by physical exercise in their post-test measurements. Individual home exercises have better effects than group outpatient exercises. Favourable results will be obtained at 8 weeks after starting treatment. CONCLUSIONS: A physical exercise programme that includes strength training, balance training, functional exercises and walking can prevent the risk of falls in patients with Alzheimer's disease in a feasible and safe way

Lessons from the COVID-19 pandemic: knowledge and preventive actions among a mexican population sample / Lecciones de la pandemia de COVID-19: conocimiento y acciones preventivas de una muestra de población mexicana

Objective: to evaluate the knowledge of the general population about the COVID-19 pandemic, including the disease and the preventive measures to reduce spreading of the virus undertaken by participants. Materials and methods: a cross-sectional study on a Mexican population sample was conducted during the period of March 20th to March 27th in Mexico, via a computer-based survey. General knowledge about COVID-19 and the adherence to recommendations were evaluated. Results: a total of 2,577 participants completed the survey. The results revealed an overall proper knowledge about the disease, with 76.2% having the proper knowledge about the disease, which was significantly correlated with age (r=0.15, p<0.001), socioeconomic status (r=0.06, p<0.003) and maximum academic level achieved by the study subjects (r=0.12, p<0.001). Conclusions: overall, people have good knowledge of COVID-19 and know about the specific public health recommendations, but a large proportion of people do not strictly follow these recommendations..Au

Objetivo: evaluar el conocimiento de la población general acerca de la pandemia de COVID-19, incluyendo datos sobre la enfermedad y las medidas preventivas para reducir la propagación del virus. Materiales y métodos: se realizó un estudio transversal en una muestra de la población mexicana durante el periodo del 20 al 27 de marzo del 2020 por medio de una encuesta electrónica. Se evaluó el conocimiento general sobre COVID-19 y el apego a las recomendaciones de salud pública Resultados: 2,577 participantes completaron la encuesta. Los resultados muestran un adecuado conocimiento sobre la enfermedad en la población general (76.2% de la muestra), el cual está levemente correlacionado con la edad (r=0.15, p<0.001), estado socioeconómico (r=0.06, p<0.003) y grado académico (r=0.12, p<0.001). Conclusiones: en general, la población conoce la información acerca del COVID-19 y conoce las recomendaciones de salud pública, pero una gran proporción de la gente no sigue estrictamente estas recomendaciones..Au

Estudo microscópico dos materiais utilizados para confecção de máscaras para proteção contra a COVID-19 / Microscopic study of materials used to make masks to protect against COVID-19

Objetivo: analisar, por meio de um estudo microscópico, os materiais utilizados para confecção das máscaras de uso da população em geral para a proteção contra a COVID-19, em relação à superfície, o tamanho, a forma e a distribuição dos poros dos mesmos. Método: estudo analítico. Foram realizadas análises de amostras de tecidos e outros materiais utilizados para confecções de máscaras para proteção da comunidade em geral contra a COVID-19 em um Laboratório de Microscopia Eletrônica e Microanálise. Resultados: a análise do tecido de algodão 100% e da sarja evidenciou esses dois tipos de tecidos como efetiva barreira microbiana. Em contrapartida, o tricoline e os demais tecidos e materiais analisados, não se apresentam como barreiras eficazes na proteção a COVID-19. Conclusão: entre os tecidos analisados, o algodão 100%, fornece uma trama mais densa, com fios mais grossos e pouca porosidade, sendo uma barreira eficaz na proteção contra infecções.

Objective: to analyze the materials used to make masks to protect against COVID-19 for use by the general population in relation to the surface, size, shape and distribution of pores by means of a microscopic study. Method: analytical study. Analyzes of fabric samples and other materials used to make masks to protect the community in general against COVID-19 were performed in an Electron Microscopy and Microanalysis Laboratory. Results: the analysis of 100% cotton and twill samples showed these two types of fabrics are an effective microbial barrier. On the other hand, tricoline and the other fabrics and materials analyzed do not offer effective barriers to protect against COVID-19. Conclusion: among the analyzed fabrics, 100% cotton has a denser weft with thicker threads and little porosity, thereby being an effective barrier to protect against infections.

Virus del Papiloma Humano: conocimiento en alumnas de Secundaria en Pachuca, Hidalgo y su impacto en la prevención / Human Papillomavirus: knowledge in students of General Secondary in Pachuca, Hidalgo

INTRODUCCIÓN: El virus del papiloma humano (VPH) es el principal factor etiológico del cáncer cervicouterino (CaCu) el cual constituye un problema de salud pública mundial, especialmente en los países en desarrollo. Se han descrito más de 120 tipos de virus de VPH, sin embargo, los tipos 16 y 18 son los responsables del 70% de los casos del cáncer cervicouterino. La importancia del conocimiento acerca de la prevención y transmisión es fundamental para evitar la infección o lograr una detección oportuna. OBJETIVO: Determinar el nivel de conocimientos sobre la prevención del VPH de las alumnas de la Escuela Secundaria General No. 10 en Pachuca, Hidalgo. MATERIALES Y MÉTODOS: Estudio transversal, observacional, la información se obtuvo a partir de un cuestionario aplicado a las alumnas de una Secundaria General en el estado de Hidalgo. Se realizó análisis descriptivo, se calcularon medidas de tendencia central y de dispersión para variables continuas y para variables cualitativas se obtuvieron razones y proporciones. RESULTADOS: El 96.5% de las encuestadas refirió haber escuchado sobre el VPH, más del 90% cree que este padecimiento es curable. Con respecto a la vacunación el 50% expresó conocer la edad en que debe ser aplicada la vacuna. Solo el 76% refirió contar con la primera dosis de la vacuna, sin embargo, sólo el 17% se aplicó todas las dosis necesarias de la misma. CONCLUSIONES: Para mejorar el nivel de salud de la población mexicana es necesario implementar programa de acciones preventivas garantizando la cobertura en vacunación contra el VPH. De no implementarse este tipo de programas los resultados no serán del todo positivo

INTRODUCTION: The human papilloma virus (HPV) is the main etiologic factor of cervical cancer (CaCu) which constitutes a global public health problem, especially in developing countries. More than 120 types of HPV virus have been described, however, types 16 and 18 are responsible for 70% of cervical cancer cases. The importance of Knowledge about prevention and transmission is essential to avoid infection or achieve early detection. OBJECTIVE: To determine the level of knowledge about HPV prevention of the students at the General Secondary School No. 1 in Pachuca, Hidalgo. MATERIALS AND METHODS: Cross-sectional, observational study, the information was obtained from a questionnaire applied to the students at a General Secondary School in the state of Hidalgo. Descriptive analyses were performed, measures of central tendency and dispersion were calculated for continuous variables and ratios and proportions were obtained for qualitative variables. RESULTS: 96.5% of the respondents reported having heard about HPV, more tan 90% believe that this disease is curable. Regarding vaccination, 50% expressed knowing the age at which the vaccine should be applied. Only 76% reported having the first doce of the vaccine, however, only 17% applied all the necessary doses ofi t. Conlusions: To improve the health leve lof the mexican population, it is necessary to implement a preventive action program guarantteing coverage in HPV vaccination. If this type of program is not implemented, the results will not be entirely positive

Riesgo de tromboembolismo venoso e implementación de medidas preventivas / Risk of venous thromboembolism and implementation of preventive measures

OBJETIVO: Identificar la frecuencia de los factores de riesgo del tromboembolismo venoso en pacientes hospitalizados y el uso de medidas preventivas adoptadas por los profesionales de la salud. MÉTODO: Estudio descriptivo, transversal y retrospectivo que incluye registros médicos de 369 pacientes adultos hospitalizados en un hospital universitario en São Paulo, Brasil, durante al menos 48 h, del 2015 al 2017. Se investigaron datos sociodemográficos, factores de riesgo clínicos para el tromboembolismo venoso, contraindicación para profilaxis química, implementación de profilaxis química y mecánica y ocurrencia de la enfermedad. Se calculó el uso de medidas preventivas siguiendo las directivas de la Sociedad Brasileña de Medicina Clínica y el riesgo de tromboembolismo venoso según la escala de predicción de PADUA (alto riesgo ≥ 4 y bajo riesgo < 4). RESULTADOS: La prevalencia de tromboembolismo venoso fue del 7,3% (n = 27). Todos los pacientes tenían al menos un factor de riesgo de tromboembolismo venoso, siendo más prevalentes la movilidad reducida (74,2%), el cáncer activo (70,7%), la infección (27,1%), la cirugía reciente (21,6%) y la edad ≥ 70 años (20,0%). Se implementó la profilaxis química en el 70,3% de los pacientes de alto riesgo sin contraindicación y la profilaxis mecánica se aplicó solo en uno de los casos con indicación. CONCLUSIONES: Todos los pacientes tenían al menos un factor de riesgo de tromboembolismo venoso; sin embargo, hubo una baja tasa de implementación de medidas preventivas por los profesionales de la salud. Por lo tanto, existe la necesidad de múltiples intervenciones, incluida la educación durante la admisión y la educación permanente de enfermeros en relación con los riesgos y la prevención, los sistemas de alerta y la auditoría de resultados

OBJECTIVE: To identify the frequency of risk factors for venous thromboembolism in hospitalized medical patients and the use preventive measures by healthcare professionals. METHOD: A descriptive, cross-sectional, retrospective study including medical charts of 369 adult patients hospitalized in the Medical sector of a university hospital in São Paulo, Brazil, for at least 48h from 2015 to 2017. Sociodemographic data, clinical risk factors for venous thromboembolism, contraindication and implementation of chemical prophylaxis, and the occurrence of the disease were investigated. The use of preventive measures was calculated by following the guidelines of the Brazilian Society of Clinical Medicine and the risk of venous thromboembolism according to the Padua Prediction Score (high risk ≥ 4 and low risk < 4). RESULTS: The prevalence of venous thromboembolism was 7.3% (n = 27). All patients had at least one risk factor for venous thromboembolism, the most prevalent being reduced mobility (74.2%), active cancer (70.7%), infection (27.1%), recent surgery (21.6%) and age ≥70 years (20.0%). Chemical prophylaxis was implemented in 70.3% of high-risk patients without contraindication and mechanical prophylaxis was applied in only one of the cases with an indication. CONCLUSIONS: All patients had at least one risk factor for venous thromboembolism. However, there was a low rate of implementation of preventive measures by health care professionals. Therefore, there is a need for multiple interventions, including admission and permanent education of nurses regarding risk and prevention, warning systems and outcomes audit

Efectividad de las medidas y estrategias de prevención de úlceras por presión en neonatos / Effectiveness of measures and strategies for the prevention of pressure ulcers in neonates

OBJETIVOS: Analizar la efectividad, en términos de disminución de la incidencia de úlceras por presión (UPP), de las medidas y estrategias preventivas de UPP en neonatos hospitalizados. MÉTODO: La recuperación de estudios se realizó a través de tres bases de datos (Medline a través de PubMed, Scopus y Science Direct) y a partir de un experto. Solamente se incluyeron en esta revisión los estudios publicados del 2007 al 2017 en español o inglés, que de forma directa o indirecta valoraran la efectividad de una medida o estrategia preventiva de UPP en neonatos hospitalizados y que en cuanto al diseño fueran o estudios clínicos controlados o cuasiexperimentales. RESULTADOS: De 100 estudios recuperados se realizó el análisis de cinco; los demás fueron excluidos por no cumplir los criterios de elegibilidad. La mayoría de los estudios analizan la efectividad de una medida preventiva de UPP secundaria al tratamiento con ventilación mecánica no invasiva en neonatos prematuros. Todos ellos tienen limitaciones en la metodología que emplean, lo que hace que la evidencia de sus recomendaciones sea baja-moderada. CONCLUSIONES: Es necesaria la realización de estudios controlados aleatorios de mayor potencia para poder recomendar alguna medida o estrategia preventiva

Objetives: The main objective of this review was to examine the effectiveness, in terms of reducing the incidence of pressure ulcers (PU), of measures and preventive strategies of PU in hospitalized infants. METHOD: The recovery of studies was carried out through three databases (Medline through Pubmed, Scopus and Science Direct), and from an expert. Only studies published from 2007-2017 in Spanish or English were included in this review, which directly or indirectly appreciate the effectiveness of a measure or preventive strategy of PU in hospitalized neonates and that in terms of design were controlled or quasi-experimental trials. RESULTS: From 100 retrieved studies was conducted analysis of 5 studies, others were excluded for failing to meet the eligibility criteria. Most studies analyze the effectiveness of a preventive measure of secondary PU to treatment with Noninvasive mechanical ventilation in preterm infants. All of the studies have limitations in the methodology used, which makes the evidence of its recommendations to be low-moderate. CONCLUSIONS: Is necessary the realization of randomized controlled studies of higher power to be able to recommend any measure or preventive strategy

Eficacia de un modelo de prevención de infección de sitio quirúrgico en un hospital de segundo nivel de atención / Effectiveness of a preventive program of surgical site infection in a hospital of second level attention

OBJETIVO PRINCIPAL: Medir la eficacia de un modelo preventivo de infecciones de sitio quirúrgico en un hospital de segundo nivel de atención en Nuevo León, México. METODOLOGÍA: Se diseñó un modelo de acciones preventivas enfocadas a disminuir la tasa de infecciones de sitio quirúrgico, las cuales se efectuaron durante los momentos preoperatorio, transoperatorio y posoperatorio. Mediante listas de verificación se observaron, vigilaron, monitorizaron y controlaron factores de riesgo para infección quirúrgica. RESULTADOS PRINCIPALES: Se logró disminuir la tasa de infecciones de sitio quirúrgico en un 2.53%, reduciendo el número de casos con respecto al periodo similar previo del estudio. Cuanto mayor fue el apego al modelo preventivo, menores los casos de infección (r=-0.61, p < 0.05). CONCLUSION PRINCIPAL: Un modelo estricto de acciones preventivas de observación, vigilancia, monitoreo y control de factores de riesgo para infecciones de sitio quirúrgico, pudo ser eficaz en la disminución de la tasa de infecciones de sitio quirúrgico

OBJECTIVE: To gauge the effectiveness of a preventive model of surgical site infections into a hospital of second level attention in Nuevo León, Mexico. METHODS: A preventive actions model was designed, focused to reduce the rate of surgical site infections, which were made during the preoperative, transoperative and postoperative moments. The risk factors for the acquisition of surgical infection were observed, looked out, monitored and controlled using checklists. RESULTS: It was possible to reduce the rate of surgical sire infections in 3%, decreasing the number of cases considerably compared to the previous similar period of the study. More attachment to the preventive model, smaller cases of infection (r=-0.61, p <0.05). CONCLUSIONS: A strict model of preventive actions like observation, surveillance, monitoring and control of risk factors for infections of surgical place, it could be effective in the decrease of the rate of surgical wound infections

Infancia y Violencia de Género: Prevención de la Mutilación Genital Femenina desde el ámbito sanitario / Childhood and Gender Violence: Prevention of Female Genital Mutilation from Healthcare sector

La Mutilación Genital Femenina (MGF) es considerada un tipo de violencia de género. Se realiza generalmente en la infancia, afectando gravemente la salud de estas niñas y mujeres. OBJETIVO PRINCIPAL: analizar los protocolos sanitarios creados para prevenir la MGF en España. METODOLOGÍA: Se ha realizado una búsqueda documental consultando las webs oficiales del gobierno central y de las Comunidades Autónomas. Se incluyeron protocolos sobre la actuación y prevención ante la MGF. RESULTADOS PRINCIPALES: 5 guías fueron seleccionadas tras excluir protocolos que no fueran exclusivamente sanitarios y aquellos anteriores al 2009. Estas guías comparten pautas de prevención para profesionales de la salud en función de la edad de la niña en riesgo. CONCLUSIÓN PRINCIPAL: para prevenir la MGF, las guías analizadas defienden una formación sanitaria transversal, incluyendo aspectos éticos y jurídicos. Proponen recursos para realizar la entrevista y pautas de actuación según edad

OBJECTIVE: Female Genital Mutilation (FGM) is considered a type of gender-based violence. It is usually done in childhood, seriously affecting the health of these girls and women. The objective of this work is to analyze the health protocols created to prevent FGM in Spain. METHODS: A documentary research has been carried out by consulting the official websites of the central government and the Autonomous Regions. Spanish protocols on action and prevention against FGM were included. RESULTS: 5 guides were selected after excluding protocols that were not exclusively sanitary and those prior to 2009. These guides share prevention guidelines for health professionals based on the age of the girl at risk. CONCLUSIONS: In order to prevent FGM, the analyzed guides defend transversal health training, including ethical and legal aspects. They propose resources to conduct the interview and guidelines for action according to age

Implantación de la Guía de buenas prácticas en prevención de lesiones por presión: desarrollo, resultados y sostenibilidad / Implementation of the best practice guideline for pressure ulcer prevention: Development, results and sustainability

OBJETIVO: Evaluar el impacto de la implantación de la guía «Valoración del riesgo y prevención de úlceras por presión» sobre la adherencia a las recomendaciones de la guía, la prevalencia de lesiones por presión (LPP) y sostenibilidad de los resultados, así como analizar las estrategias de implantación, la sostenibilidad y las barreras detectadas. MÉTODO: Estudio observacional retrospectivo (de junio del 2015 a diciembre del 2018). Se estudiaron 2periodos (P1: preparación y P2: sostenibilidad). Se analizaron las memorias del programa y los datos de la historia clínica de pacientes dados de alta en los 4hospitales participantes sobre la adherencia de las recomendaciones preventivas y los resultados en salud en términos de presencia de LPP por cada centro. RESULTADOS: Se incluyó a 13.515 pacientes, de los cuales 4.523 tenían riesgo de LPP y 722 tenían LPP. El 82,9% de los pacientes recibieron una valoración del riesgo de LPP al ingreso. Se observó una disminución de esta valoración al ingreso: P1: 89,1% vs. P2: 81%; p < 0,001. El 42,1% de los pacientes de riesgo fueron reevaluados durante el ingreso, observándose un aumento significativo entre los períodos: P1: 30,7% vs. P2: 46%; p < 0,001. El 63,2% contaba con una superficie especial de manejo de presión, con un aumento significativo: P1: 55,3% vs. P2: 65%; p < 0,001. La prevalencia global de LPP fue del 5,5%, observándose una disminución significativa al comparar P1: 6,6% vs. P2: 5,1%; p = 0,003. La prevalencia de LPP nosocomiales fue del 2,1%, manteniéndose constante P1: 2% y P2: 2,1%; p = 0,708. El compromiso institucional, la designación de líderes, elaboración de planes de acción y la formación son estrategias destacables en todos los centros. CONCLUSIONES: El presente estudio muestra la existencia de una adecuada adherencia a las principales recomendaciones de la guía, observándose una mejoría estadísticamente significativa en la adherencia a 2 de las 3 recomendaciones evaluadas. Las estrategias de implantación y sostenibilidad puestas en marcha han contribuido en el mantenimiento o mejora de los resultados en el tiempo

AIM: To assess the impact of implementing the "Risk Assessment and Prevention of Pressure Injuries (PI)" guideline on adherence to its recommendations, the prevalence of PI and the sustainability of results, and to analyse the implementation strategies, sustainability and barriers detected. METHODS: A retrospective observational study (June 2015 to December 2018). Two periods were studied (P1: Preparation and P2: Sustainability). The programme reports and data from the medical records of patients discharged from the 4participating hospitals were analysed with regard to adherence to preventive recommendations and health outcomes in terms of the presence of pressure injuries per centre. RESULTS: A total of 13,515 patients were included, of whom 4,523 were at risk for PI and 722 had PI. Of the patients, 82.9% underwent a risk assessment for PI on admission. A decrease in this assessment on admission was observed between P1:89.1% vs. P2: 81% P<.001. Of the patients at risk, 42.1% were reassessed during their admission and a significant increase was observed between the periods P1: 30.7% vs. P2:46%; P<.001. 63.2% had a special pressure management surface, with a significant increase between P1:55.3% vs. P2: 65%; P<.001. The overall prevalence of PI was 5.5% and a significant decrease was observed on comparing P1: 6.6% vs. P2:5.1%; P=.003. The prevalence of nosocomial PI remained constant at 2.1%, P1:2% and P2:2.1%; P=.708. Institutional commitment, the appointment of leaders, drawing up of action plans, and training are outstanding strategies in all the centres. CONCLUSIONS: This study shows that there is adequate adherence to the main recommendations of the guideline. A statistically significant improvement was observed in adherence to 2 out of the 3 recommendations assessed. The implantation and sustainability strategies implemented have been contributed to maintenance and/or improving results over time

Resultados iniciales del Programa de prevención Ícaro-Alcohol / Initial results of the preventive Ícaro-Alcohol Programme

El consumo nocivo de alcohol en los jóvenes es un problema de salud pública sobre el que es necesario actuar. La intervención sobre los casos que acuden a urgencias es una actuación en crisis que puede ser efectiva. Se presentan los resultados iniciales del Programa Ícaro-Alcohol (detección de menores de 22 años atendidos en Urgencias/Emergencias por consumo de alcohol, Intervención Motivacional Breve (IMB) y derivación al Servicio de Referencia de Prevención (SRP) y a los programas preventivos, para reducir este consumo. Participaron los Hospitales Universitarios Río Hortega (HURH) y Clínico (HCUV) y Unidades Medicalizadas de Emergencias (UME) de Valladolid capital. El 53,8% (n = 27) de los profesionales recibieron formación sobre el programa (73,3% HURH vs 45,6% HCU) y el 17,4% (n = 41) entrena-miento en IMB para realizarla in situ, aprovechando la situación "de crisis" derivada de la urgencia (26,7% HURH vs 12,6% HCUV).Entre junio y diciembre de 2017 se atendieron 93 urgencias relacionadas con alcohol, las UME derivaron todas a los hospitales; 49 cumplían el criterio de caso, se intervino en 21 (43%) y se derivaron 8 casos al SRP (38% de los que se intervino, 16% del total de casos). La intervenciones y derivaciones fueron mayores en el hospital con mayor participación en la formación. Los casos de mayor edad acudían a horas más tardías, presentaron problemática asociada y accedieron menos a la derivación. Los tiempos de derivación a prevención indicada se cumplieron, pero no a los programas universales y selectivos Se mejora el protocolo de actuación centrándose en los menores 18 años, simplificando el consentimiento, mejorando la formación en IMB simplificando la intervención de los profesionales y realizando la intervención preventiva individual desde los SRP de forma inmediata. El programa se implantará progresivamente en el resto de provincias de Castilla y León

Harmful alcohol consumption among young people is a public health problem that needs important measures. Interventions in emergency department cases, such as crisis action, could be effective. The initial results of the Icaro-Al-cohol Program (detection of young people under 22 years attended in the emergency department for alcohol consumption, a Brief Motivational Intervention (BMI) and referral to a prevention reference service (PRS) and prevention programs) are presented. The program objective is to reduce the harmful use of alcohol. Río Hortega University Hospital (HURH), Clínico Hospital (HCUV) and Medical Emergency Units (MEUs) were involved in the study developed in the city of Valladolid (Castilla y León, Spain). Training in program implementation was given to 53.8% of professionals (n = 27) (73.3% HURH vs 45.6% HCUV), while 17.4% (n = 41) were trained to develop BMI in the critical situation derived from the emergency (26.7% HURH vs 12.6% HCUV). A total of 93 cases were treated by the hospital emer-gency services, and all the cases treated by the MEUs were referred to the hospital, between June and December 2017. There were 49 urgent cases, and interventions were carried out in 21 of them (43%). Afterwards, 8 cases were referred to the PRS (38% of 21 intervened; 16% of the total number of cases). Interventions and referrals were greater in the hospital with more trained professionals. The older youth cases arrived last at night. They had other health problems associated and were less likely to agree to referral. The refer-ral times to indicated prevention programs were met, but not to universal and selective programs.The action protocol is improved by focusing on children under 18, simplifying consent, improving BMI training, sim-plifying the intervention of professionals and carrying out individual preventive intervention from the PRSs immediately. The program will be implemented progressively in the rest of the provinces in Castilla y León

Mental health among college users of mental health services: suicide risk screening and prevention strategies / Salud mental en universitarios usuarios de servicios de salud mental: detección de riesgo suicida y estrategias preventivas

OBJECTIVE: The goal of this study was to assess the mental health among college users of psychological care services, to identify their suicidal risk and discuss mental health promotion and the relevance of suicide prevention strategies within this population. METHOD: 145 college students between 17 and 26 years old (m= 20.81, σ=1.9) answered psychological tests (validated for Mexican population) including an Informed Consent Form, the World Health Organization Quality of Life Questionnaire BREF (WHOQoL-BREF), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI). RESULTS: The analysis showed that more than a half of participants had suicidal ideation (50.34%), moderate-high symptomatology of anxiety (63.89%), depression (58.70%) and quality of life close to the mean score in all the factors (49.40-51.27). CONCLUSIONS: The results showed that college student users of psychological care services have high anxiety and depression symptomatology and it is worse if there is suicidal ideation, however, the results are not consistent with the WHO-QoL BREF that indicates that there is no affectation in the psychological area

OBJETIVO: El propósito del estudio fue evaluar la salud mental de universitarios usuarios de servicios de salud mental, identificar el riesgo de suicidio y discutir sobre la promoción de salud mental y lo relevante de estrategias de prevención en esta población. MÉTODO: 145 estudiantes universitarios en edades de entre 17-26 años (m= 20.81, σ=1.9) respondieron un conjunto de tests psicológicos (validados para población mexicana) y que estuvieron conformados por: consentimiento informado, el cuestionario breve de calidad de vida de la Organización Mundial de la Salud (WHOQoL-BREF), Inventario de Ansiedad de Beck (BAI), Inventario de Depresión de Beck (BDI). RESULTADOS: El análisis mostró que más de la mitad de los participantes presentaban ideación suicida (50.34%), sintomatología de moderada a grave de ansiedad (63.89%), depresión (58.70%) y puntajes cercanos a la media en todos los factores del instrumento de calidad de vida (49.40-51.27). CONCLUSIONES: Los resultados mostraron que los universitarios usuarios de los servicios de atención psicológica tienen alta sintomatología de ansiedad y depresión y que ésta es peor cuando existe presencia de ideación suicida. Sin embargo, los resultados no son consistentes con los obtenidos en el WHOQoL-BREF ya que este último cuestionario indica que no existe una afectación en el área psicológica

Impacto de los factores de riesgo cardiovascular en la población extremeña: aportación de la cohorte HERMEX para una estrategia preventiva / Impact of cardiovascular risk factors in the Extremadura population: HERMEX cohort contributions for a preventive strategy

OBJETIVO: Determinar la fracción atribuible poblacional (FAP) de los factores de riesgo (FR) clásicos para la aparición de la enfermedad cardiovascular en una cohorte poblacional de Extremadura, a fin de recomendar intervenciones preventivas prioritarias. MÉTODOS: DISEÑO: estudio de cohortes. Emplazamiento: Muestra poblacional representativa de un área de salud de Extremadura (España). PARTICIPANTES: Dos mil ochocientos treinta y tres individuos, de 25 a 79 años, seleccionados aleatoriamente e incluidos entre 2007 y 2009. Se registraron antecedentes y se midieron parámetros clínicos, siendo seguidos hasta el 31 de diciembre de 2015. Mediciones: Variables explicativas: edad, sexo, obesidad, tabaquismo, hipertensión arterial (HTA), diabetes mellitus (DM) e hipercolesterolemia. Variable resultado: Primer evento de la variable combinada de infarto de miocardio, angina de pecho, ictus, isquemia de miembros inferiores y muerte cardiovascular. Se calcularon las hazard ratio mediante regresión de Cox, totalmente ajustadas y las FAP mediante la fórmula de Levin. RESULTADOS: Se analizaron 2.669 sujetos de la cohorte inicial, al ser excluidos 103 por antecedentes de enfermedad cardiovascular y 61 por pérdidas. El seguimiento fue de 6,9 años (RI: 6,5-7,5). Se documentaron 134 eventos. Tasa de incidencia 7,42/1.000 personas-año. Las hazard ratio ajustadas (IC 95%) fueron: HTA 2,26 (1,40-3,67), hipercolesterolemia 2,23 (1,56-3,18), DM 1,79 (1,24-2,58), tabaquismo 1,72 (1,11-2,69). Las FAP (IC 95%) fueron HTA 31,1 (12,4-48,8), hipercolesterolemia 27,0% (14,8-40,6), tabaquismo 18,8% (3,3-35,0), DM 7,9% (2,6-15,2). CONCLUSIONES: La HTA es el FR con mayor impacto en la salud cardiovascular de la población extremeña, seguido de hipercolesterolemia y tabaquismo, constituyendo objetivos prioritarios para una estrategia preventiva poblacional

OBJECTIVE: To determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health. METHODS: Design, Cohort study. LOCATION: Representative population sample of a health area of Extremadura (Spain). PARTICIPANTS: 2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done. Measurements: Explanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia. Outcome variable: First event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula. RESULTS: 2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3-35.0) and DM 7.9% (2.6-15.2). CONCLUSIONS: Hypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy

Conhecimento dos enfermeiros antes e após um programa educativo, sobre prevenção de quedas na população idosa em contexto comunitário / Knowledge of nurses before and after an educational program on prevention of falls in elderly population in a community context

Introduction: In good organizational practice, health professionals should be provided with training programs for fall prevention. Aims: To evaluate the impact of an educational program for nurses on the prevention of falls in the elderly population in a community context. Method: This study supports the intervention phase of an Action-Research investigation. Was implemented a training program, with two steps: sensitization (S) and formation (F) held in a group of North Health Centers of Portugal. In the S step, 154 professionals from different areas participated. In the F step, 67 nurses participated. The S step occurred between February and March of 2017. The satisfaction of the training was assesseded. The F step enrolled five sessions, performed between May and June 2017. The target group of this stage were only nurses. In addition to the assessment of training satisfaction, a questionnaire was useded (pre-test). We used descriptive analysis and comparison of means using the IBM SPSS 25.0 software. The Ethics Committee for North Health centers (nº 97/2014) approved the study. Results: In the S step, were represented all the professional areas, but the physi-cians (43.8%) were more representative. In F step, the sample of nurses is mostly female (80.6%), with an age between 32-60 years. The professional activity years of nurses vary between 8 and 36 years. In the overall assessment of training satisfaction, it was verified that the training dimension (mean 3.71 and mean 3.67), respectively in sessions 3 and 5, was the most valued. Conclusion: The program revealed improvement in nurses' knowledge

No disponible

Intervenções eficazes na prevenção ou redução da sobrecarga do familiar cuidador: revisão sistemática da literatura / Effective interventions for the prevention and reduction of the family caregiver burden: a systematic literature review

The family caregiver role is highly demanding and very likely to trigger burden. A systematic literature review was conducted in order to identify effective interventions for the prevention/reduction of the family caregiver burden. A search was conducted in SCOPUS, Web of Science and EBSCO databases from 2006 to 2016. Ten studies were selected involving different interventions (educational, psychoeducational, psycho-social and psycho-socio-educational). Despite the positive results of the different types of approach, the educational and multicomponent programmes revealed the most favorable outcomes. Considering the methodological heterogeneity observed, multicenter, longitudinal, prospective, controlled and mixed methodology studies should be carried out, leading to high-quality evidence-based results

No disponible

Efetividade da intervenção do enfermeiro especialista de reabilitação na prevenção de complicações à pessoa submetida a cirurgia / Effectiveness of the intervention of the rehabilitation specialist nurse in the prevention of complications for the person undergoing surgery

Os procedimentos cirúrgicos aumentam as alterações funcionais assim como, o stress fisiológico e psicológico na pessoa submetida a cirurgia, resultando no compromisso das atividades de autocuidado e assim no aumento da morbilidade e mortalidade. As complicações major são a nível pulmonar, cardíaco e associadas à imobilidade. O aumento de 43,7% da atividade cirúrgica em Portugal entre 2006 e 2014 legítima a efetividade da intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação na prevenção de complicações pós-operatórias, contribuindo para o controlo sintomático e promoção do bem-estar à pessoa submetida a cirurgia. O presente Relatório de Estágio descreve, reflete e analisa criteriosamente, o percurso realizado ao nível do Mestrado em Enfermagem na Área de Especialização em Enfermagem de Reabilitação na ESEL durante o estágio, com o intuito de adquirir e desenvolver as competências preconizadas nos descritores de Dublin para o 2º ciclo de ensino para a obtenção do grau de Mestre em articulação com as competências definidas pela Ordem dos Enfermeiros para a atribuição do título profissional de Enfermeiro Especialista em Enfermagem de Reabilitação. Assim, procurámos compreender a efetividade da intervenção do EEER na prevenção de complicações na pessoa adulta/idosa submetida a cirurgia, uma vez que é considerada uma necessidade de investigação emergente de acordo com o Colégio da Especialidade. Na sua consecução, consideramos a Teoria do Autocuidado de Orem assim como o Nursing Role Effectiveness Model de Doran, para tal realizou-se uma revisão narrativa da literatura. Na abordagem à pessoa adulta/idosa em processo cirúrgico constataram-se como resultados sensíveis à intervenção autónoma do EEER o controlo sintomático pela melhoria da dor, da ventilação e tolerância ao esforço. Ao nível do autocuidado e do estado funcional verificou-se maior autonomia na satisfação das necessidades de autocuidado, melhoria da força muscular e equilíbrio, maior eficácia na marcha e melhoria da qualidade de vida.

Surgical procedures increase functional changes as well as physiological and psychological stress in the person undergoing surgery, resulting in compromised selfcare activities and thus increased morbidity and mortality. Major complications are pulmonary, cardiac and associated with immobility. The 43.7% increase in surgical activity in Portugal between 2006 and 2014 legitimizes the effectiveness of the intervention of the Specialist Nurse in Rehabilitation in the prevention of complications, contributing to the symptomatic control and promotion of well-being to the person undergoing surgery. This Internship Report carefully describes, reflects and analyses the path taken at the level of the Master's Degree in Nursing in the Specialization Area of Rehabilitation Nursing at ESEL during the internship, with the aim of acquiring and developing the skills recommended in the Dublin descriptors for the second cycle to obtain the Master's degree in conjunction with the competencies defined by the Order of Nurses for the attribution of the professional title of Specialist Nurse in Rehabilitation Nursing. Thus, we sought to understand the effectiveness of the rehabilitation nurse intervention in preventing complications in the adult / elderly person undergoing surgery, since it is considered an emerging research need according to the College of Specialty. In achieving this, we considered Orem's Self-Care Deficit Nursing Theory as well as Doran's Nursing Role Effectiveness Model, for which a narrative literature review was performed. In the approach to the adult / elderly person undergoing a surgical procedure, symptomatic control for improving pain, ventilation and effort tolerance was found to be sensitive to autonomous rehabilitation nurse intervention. At the level of self-care and functional status, there was greater autonomy in meeting the needs of self-care, improved muscle strength and balance, greater efficiency in walking and improved quality of life.

Evaluación de los programas para disminuir el consumo de alcohol en España: un tema pendiente / Evaluation of programs to reduce alcohol consumption in Spain: a pending issue

OBJETIVO: Hace tiempo que se recomienda evaluar las intervenciones preventivas en España. La evaluación del impacto de los programas estructurados y de las acciones puntuales de prevención y tratamiento del consumo de alcohol (PAPTCA) permitiría tomar las decisiones de financiación mejor informadas en materia de salud pública, desde el punto de vista de la eficiencia. No obstante, no se conoce un documento que ilustre la situación de la evaluación de los PAPTCA en España. Este artículo pretendió clasificar y describir los PAPTCA en España, prestando especial atención a la evaluación de impacto y a la información sobre financiación para la rendición de cuentas. MÉTODOS: Se realizó una revisión bibliográfica sistematizada de los PAPTCA implementados en España tanto a nivel regional (comunidades autónomas) como local durante el periodo 2000-2017, y se llevó a cabo un análisis descriptivo de la base de datos obtenida de los PAPTCA a partir de la revisión de la bibliografía realizada. RESULTADOS: Se identificaron 145 programas estructurados y 45 acciones puntuales. Solo el 25% de los programas estructurados evaluaron los resultados. Además, únicamente un tercio de ellos presentaron alguna información sobre su financiación. Por su parte, los números fueron menos alentadores en las acciones puntuales, donde solo el 10% evaluaron sus resultados, y una cifra similar aportó información sobre su financiación. CONCLUSIONES: Existe una necesidad de sistematizar la información de los PAPTCA, para que sirva de instrumento en la evaluación de su impacto en España y, de esta manera, paliar la escasa presencia de cultura evaluativa en este ámbito y promover la rendición de cuentas a la sociedad de los recursos en salud pública

OBJECTIVE: To evaluate preventive interventions on alcohol consumption has been long recommended in Spain. The impact evaluation of structured programs and specific actions for the prevention and treatment of alcohol consumption (PAPTCA) would allow making better informed decisions on public health financing based on the efficiency criteria. To the best of our knowledge, there is no scientific document that illustrates the situation of the PAPTCAs' evaluation in Spain. This paper aims to classify and describe PAPTCAs in Spain, focused on their impact evaluation and information on financing for accountability to society. METHODS: A systematic literature review of the PAPTCAs implemented in Spain, from 2000 till 2017, at regional (autonomous communities) and local level was carried out, and a descriptive analysis of the PAPTCA database obtained from the literature review was carried out. RESULTS: 145 structured programs and 45 specific actions were identified. Only 25% of structured programs provided an impact evaluation, besides, only 15% presented some information about their financing. Regarding the specific actions, the numbers were less encouraging where 10% provided an impact evaluation while a similar figure of PAPTCAs showed financing information. CONCLUSIONS: There is a need to systematize the information of the PAPTCA that serves as an instrument to conduct impact evaluations in Spain. This should ease the scarce presence of evaluative culture in this area and promote the accountability of resources spent on public health to society