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Environ Monit Assess ; 194(9): 648, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35931859


Rice cultivation is a major source of methane (CH4) emissions. Intermittent irrigation systems in rice cultivation, such as the mid-season drainage (MSD), are effective strategies to mitigate CH4 emissions during the growing season, though the reduction rates are variable and dependent on the crop context. Aeration periods induce alteration of soil CH4 dynamics that can be prolonged after flooding recovery. However, whether these changes persist beyond the growing season remains underexplored. A field experiment was conducted in Spain to study the effect of MSD implemented during the rice growing season on greenhouse gas (GHG) emissions in relation to the standard permanently flooded water management (PFL). Specifically, the study aimed at (1) assessing the CH4 mitigation capacity of MSD in the studied area and (2) testing the hypothesis that the mitigating effect of MSD can be extended into the following winter flooded fallow season. Year-round GHG sampling was conducted, seasonal and annual cumulative emissions of CH4 and N2O as well as the global warming potential were calculated, and grain yield was measured. MSD reduced growing season CH4 emissions by ca. 80% without yield penalties. During the flooded fallow season, MSD reduced CH4 emissions by ca. 60%, despite both fields being permanently flooded. The novelty of our observations lies in the amplified mitigation capacity of MSD by extending the CH4 mitigation effect to the following flooded winter fallow season. This finding becomes especially relevant in rice systems with flooded winter fallow season given the large contribution of this season to the annual CH4 emissions.

Gases de Efeito Estufa , Oryza , Agricultura , Monitoramento Ambiental , Metano/análise , Óxido Nitroso/análise , Estações do Ano , Solo , Espanha
PLoS One ; 17(8): e0272549, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925982


BACKGROUND: Following the active ageing model based on the Health, Lifelong Learning, Participation and Security pillars, this research has a twofold objective: i) to classify older adults according to active ageing profiles, taking into account the four pillars, and ii) to ascertain the relationship between the profiles and personal and contextual factors, as well as well-being and quality of life in old age. METHODS: A study sample of 5,566 Spanish older adults who participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was included. Data were analysed in different steps applying several statistical analyses (Principal Component, Cluster, Discriminant, Multiple Correspondence and bivariate analysis with Pearson chi-square and ANOVA). RESULTS: Five older adult profiles were obtained (I: with moderate activity; II: quasi-dependents; III: with active ageing-limiting conditions; IV: with diverse and balanced activity; V: with excellent active ageing conditions). The first three profiles were characterised by subjects with a high average age, low educational level, who were retired or housewives, and who perceived a moderate level of loneliness, satisfaction with the social network and quality of life, as well as having a larger family network, but living in small households or alone. In contrast, the latter two profiles showed better personal and contextual conditions, well-being and quality of life. DISCUSSION AND CONCLUSIONS: The multidimensional approach to active ageing followed in this article has revealed the presence of several older adult profiles, which are confined to groups with better or worse active ageing conditions. In this context, if ageing is a process that reflects the previous way of life, intervention priorities will have to consider actions that promote better conditions during the life cycle.

Qualidade de Vida , Aposentadoria , Idoso , Envelhecimento , Europa (Continente) , Humanos , Análise Multivariada , Espanha
Harmful Algae ; 117: 102271, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35944952


The study of epibenthic assemblages of harmful dinoflagellates (BHABs) is commonly conducted in shallow infralittoral zones (0 - 5 m) and are seldom investigated at deeper waters. In this study, the distribution with depth of five BHAB genera (Gambierdiscus, Ostreopsis, Prorocentrum, Coolia and Amphidinium) was investigated in the south of El Hierro island (Canary Islands, Spain). Sampling involved the use of a standardized artificial substrate deployed at three depth levels (5, 10 and 20 m) that were visited at three different times throughout one year. The influence of three depth-correlated abiotic parameters, i.e. light, water motion and water temperature, on the vertical and seasonal distribution of the BHAB assemblage was also assessed. Two vertical distribution patterns were observed consistently through time: cell abundances of Ostreopsis and Coolia decreased from 5 to 20 m while those of Gambierdiscus, Prorocentrum and Amphidinium showed the reverse pattern, although significant differences were only observed between 5 and 10 - 20 m depth. In April, two members of the latter group, Gambierdiscus and Amphidinium, were even absent at 5 m depth. The recorded environmental parameters explained a high percentage of the observed distribution. In particular, model selection statistical approaches indicated that water motion was the most significant parameter. An analysis of Gambierdiscus at species level revealed the co-occurrence of four species in the study area: G. australes, G. belizeanus, G. caribaeus and G. excentricus. The species G. excentricus, reported here for the first time in El Hierro, showed a more restricted vertical and seasonal distribution than the other species, which may explain not being detected in previous studies in the area. The results obtained in this study highlight the importance of considering a wider depth range and different seasons of the year when investigating the ecology of BHABs and assessing their risk and impacts on human health and the environment. Only then, efficient monitoring programs will be implemented in the Canary Islands and globally in areas affected by these events.

Dinoflagelados , Humanos , Espanha , Temperatura , Água
BMJ Open ; 12(8): e058799, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918108


OBJECTIVES: We aimed to quantify patient preferences for efficacy, safety and convenience features of atopic dermatitis (AD) treatments. DESIGN AND SETTING: Online discrete choice experiment survey. PARTICIPANTS: Adults in the UK, France and Spain who had used AD treatments during the past 2 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Preferences for attributes were analysed using a multinomial logit model. Willingness to make trade-offs was expressed as the maximum acceptable decrease (MAD) in the probability of achieving clear/almost clear skin at week 16. RESULTS: The survey was completed by 404 patients (44.1±12.0 years; 65% women; 64% moderate/severe eczema). Most patients (68%) had no prior experience of using self-injectable treatments for AD or any other illness. Participants most valued increasing the chance of achieving a meaningful reduction in itch at week 16 from 20% to 50%, followed by reducing the risks of serious infections from 6% to 0% and of eye inflammation from 20% to 0%. Participants were willing to accept a decrease in the possibility of achieving clear/almost clear skin to obtain a treatment that can be paused (MAD=24.1%), requires occasional check-ups (MAD=16.1%) or no check-ups (MAD=20.9%) over frequent check-ups, is administered as a one time per day or two times per day oral pill versus a subcutaneous injection every 2 weeks (MAD=16.6%), has a 2-day over 2-week onset of action (MAD=11.3%), and can be used for flare management (MAD=5.8%). CONCLUSIONS: Although patients with AD most valued treatment benefits and risks, they were willing to tolerate reduced efficacy to obtain a rapid onset, oral administration, less frequent monitoring and a treatment that can be paused. Understanding patients' preferences for AD therapies, including new targeted therapies, can aid shared decision-making between clinicians and patients and support health technology assessments.

Dermatite Atópica , Preferência do Paciente , Adulto , Comportamento de Escolha , Dermatite Atópica/tratamento farmacológico , Feminino , França , Humanos , Masculino , Espanha , Reino Unido
Rev Esp Salud Publica ; 962022 Jul 26.
Artigo em Espanhol | MEDLINE | ID: mdl-35909345


OBJECTIVE: Hip fracture (HF) in the elderly carries high mortality and decreases functionality and quality of life after one year. The aim of this paper was to identify risk factors that influenced functionality (Barthel) and quality of life (EQ-5D) of the elderly with osteoporotic HF. METHODS: A prospective observational study was made in people over 65 years of age with HF between October 2017 and November 2018. Clinical information was collected from the digital medical record and the scales were measured by telephone at four times: baseline, one month, six months and twelve months. Statistical analysis was made thanks to SPSS vs 25.0. Multivariate analysis was performed using a generalized linear model for repeated measures to determine the relationship of risk factors with functionality and quality of life. RESULTS: Functionality showed significant differences (p<0.001) between baseline measurement and one month (90 points vs 50); baseline and at twelve months (90 vs 60 points); and that of the month and at twelve months (50 points vs 60). Quality of life also presented significant differences (p<0.001) between baseline and one month (0.587 vs 0.113); and baseline and twelve months (0.220). The functionality should be in transfused and with high surgical risk (p<0.05) and the quality of life will arrive in high surgical risk (p=0.017). Those older than 85 years were the ones who recovered the least after one year, as well as patients with delirium on admission and those who received transfusions. Patients with iron therapy recovered better at six months compared to those who did not and maintained this improvement at twelve months. CONCLUSIONS: Among the main risk factors are advanced age, male sex, transfused, high surgical risk, delirium on admission and malnutrition.

OBJETIVO: La fractura de cadera (FC) en mayores de 65 años conlleva alta mortalidad y una disminución de la funcionalidad y la calidad de vida al año. El objetivo de este estudio fue identificar factores de riesgo que influyeran en la funcionalidad (Barthel) y en la calidad de vida (EQ-5D) en mayores de 65 años con FC osteoporótica. METODOS: Se realizó un estudio observacional prospectivo en mayores de 65 años con FC entre octubre de 2017 y noviembre de 2018. Desde la historia clínica digital se recogió la información clínica y telefónicamente se midieron las escalas en cuatro momentos: basal, un mes, seis meses y doce meses. El análisis estadístico se efectuó mediante el programa informático SPSS (versión 25.0). Se realizó análisis multivariante mediante un modelo lineal generalizado para medidas repetidas para determinar la relación de los factores de riesgo con la funcionalidad y la calidad de vida. RESULTADOS: La funcionalidad presentó diferencias estadísticamente significativas (p<0,001) entre la medición basal y al mes (90 puntos frente a 50), la basal y a los doce meses (90 frente a 60 puntos), y la del mes y a los doce meses (50 puntos frente a 60). La calidad de vida también presentó diferencias estadísticamente significativas (p<0,001) entre el basal y al mes (0,587 frente a 0,113) y la basal y a los doce meses (0,220). La funcionalidad disminuyó en transfundidos y con riesgo quirúrgico alto (p<0,05) y la calidad de vida decreció en riesgo quirúrgico alto (p=0,017). Los mayores de 85 años fueron los que menos recuperaron al año, al igual que los pacientes con delirium al ingreso y los transfundidos. Los pacientes con ferroterapia se recuperaron mejor a los seis meses respecto a los que no y mantuvieron esta mejoría a los doce meses. CONCLUSIONES: Entre los principales factores de riesgo están la edad avanzada, el sexo masculino, ser transfundidos, el riesgo quirúrgico alto, el delirium al ingreso y la desnutrición.

Delírio , Fraturas do Quadril , Idoso , Fraturas do Quadril/cirurgia , Humanos , Masculino , Qualidade de Vida , Fatores de Risco , Espanha
Inquiry ; 59: 469580221109970, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35912432


Dentists in Spain reached equal gender representation in 2012 and the number of female dentists has continued to grow (until 57.3% in 2020). This study aims to increase evidence about the gender distribution on the high responsibility positions and opinion leaders of the dental profession and academia. Composition of the executive comities of the main dental institutions of Spain (regional professional associations, national dental association, and scientific societies), members of the Faculty of Dentistry of the University of Granada in 2020 and speakers of the main dental congresses of 2019 (due to the lack of congress in 2020) were recorded and analyzed by genders using chi-squared test (P < .05). Mean representation of female dentists in executive committees of professional associations was 35.6%. More than 70% of presidents and vice-presidents of professional colleges and more than 60% of these positions in scientific societies were occupied by male dentists. None of dental congresses of 2019 reached equal gender participation, being 81.3% of lecturers presenting on main auditoriums male dentists. Although dental workforce in Spain is slightly overrepresented by females, leadership positions and figures among Spanish dentists doesn't seem to reflect the gender distribution of the collective. There is a lack of women occupying high-level positions in dentistry that proves the existence of the so-called "glass ceiling effect" on the profession. Further studies about sociodemographic aspects of dental workforce are needed to develop evidence-based policies for the collective.

Odontologia/organização & administração , Odontólogas , Liderança , Feminino , Humanos , Masculino , Espanha , Universidades
BMJ Open ; 12(8): e059370, 2022 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-35948385


OBJECTIVE: To estimate smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain. DESIGN: Nationwide, observational study from 2016 to 2019. Population-attributable fractions were used to estimate age, sex and education-specific cause-of-death smoking-attributable mortality. Life table techniques and decomposition methods were used to estimate potential gains in life expectancy at age 35 and the cause-specific contributions of smoking-related mortality to life expectancy differences across educational groups. SETTING: Spain. PARTICIPANTS: We use cause-specific mortality data from population registers and smoking prevalence from the National and the European Health Survey for Spain from 2017 and 2019/2020, respectively. RESULTS: We estimated 219 086 smoking-related deaths during 2016-2019, equalling 13% of all deaths, 83.7% of those in men. In the absence of smoking, potential gains in male life expectancy were higher among the low-educated than the high-educated (3.1 vs 2.1 years). For women, educational differences were less and also in the opposite direction (0.6 vs 0.9 years). The contribution of smoking to life expectancy differences between high-educated and low-educated groups accounted for 1.5 years among men, and -0.2 years among women. For men, the contribution of smoking to these differences was mostly driven by cancer in middle age, cardiometabolic diseases at younger ages and respiratory diseases at older ages. For women, the contribution to this gap, although negligible, was driven by cancer at older ages among the higher educated. CONCLUSIONS: Smoking remains a relevant preventable risk factor of premature mortality in Spain, disproportionately affecting life expectancy of low-educated men.

Expectativa de Vida , Neoplasias , Adulto , Causas de Morte , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Fumar/epidemiologia , Espanha/epidemiologia
PLoS One ; 17(8): e0271484, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35921271


Transgender identities are still considered a psychiatric pathology in many countries according to the prevailing biomedical model. However, in recent years, this pathologizing vision has begun to shift towards a perspective that focuses on the diversity of transgender peoples' experiences. However, some transgender people still face denial of services, discrimination, harassment, and even violence by healthcare professionals, causing them to avoid seeking ongoing or preventive healthcare. This article describes the health experiences of transgender people in Barcelona regarding their access and use of non-specialized health services. Semi-structured interviews were conducted using a descriptive phenomenological approach with sixteen transgender people between December 2018 and July 2019. The data were analyzed descriptively and thematically following the method proposed by Colaizzi with the help of the Atlas.ti8 software. Transgender people care experiences were divided into three categories: overcoming obstacles, training queries, and coping strategies. Participants identified negative experiences and difficulties with the health system due to healthcare providers' lack of competence. Discriminatory, authoritarian, and paternalist behaviors are still present and hinder the therapeutic relationship, care, and access to healthcare services. There is a fundamental need for the depathologization of transgender reality and training for healthcare professionals in the field of sexual diversity. Training in sexual and gender diversity must be included in the curricula of university courses in the health sciences.

Atitude do Pessoal de Saúde , Acesso aos Serviços de Saúde , Pessoas Transgênero , Transexualidade , Adaptação Psicológica , Atenção à Saúde , Humanos , Pesquisa Qualitativa , Espanha , Pessoas Transgênero/psicologia
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 41(4): 223-230, jul. - ago. 2022. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-205184


Objetivo: Conocer el estado actual de la técnica de localización radioguiada de lesiones no palpables de mama con o sin indicación de biopsia selectiva de ganglio centinela —ROLL, SNOLL y semillas de 125I— mediante la realización de una encuesta nacional elaborada por el Grupo de Trabajo de Cirugía Radioguiada (GTCRG) de la Sociedad Española de Medicina Nuclear e Imagen Molecular (SEMNIM). Material y métodos: En octubre del 2020 se envió la encuesta, en formato digital, a los distintos servicios de Medicina Nuclear de nuestra geografía. Se dio un tiempo de respuesta de 2meses con prórroga de 15 días. Se ha obtenido el número de procedimientos ROLL/SNOLL de cada centro y la metodología utilizada, recogiendo importantes detalles técnicos. Además, se ha incluido un apartado específico sobre las semillas de 125I. Los resultados se volcaron de forma automática en una hoja de cálculo Excel 2007 para su posterior análisis con el mismo programa. Resultados: La encuesta fue contestada por 55 centros; 21 utilizan arpón mientras que los 34 restantes emplean distintas técnicas de cirugía radioguiada (CRG) para la localización de lesiones no palpables de mama, desglosando los resultados en 13apartados. La dosis de trazador habitualmente utilizada es de 111 MBq para la técnica ROLL y de 222 MBq para la técnica SNOLL, con un volumen de 0,2ml. El protocolo más habitual es el de 2días. El 26% de los centros que realiza CRG utiliza semillas de 125I tanto para la detección de lesiones mamarias como de ganglios sospechosos/patológicos, siendo el tiempo entre la implantación y la extirpación es de unos 3 días, con posterior control radiológico en la mayoría de los casos. Conclusión: La encuesta pone de manifiesto la relevancia de la cirugía radioguiada en el manejo de los pacientes con cáncer de mama en las diferentes etapas de la enfermedad, con disparidad en la implementación de las nuevas técnicas y herramientas (AU)

Objective: To know the current status of the technique of radioguided localisation of non-palpable breast lesions with or without indication for selective sentinel node biopsy -ROLL, SNOLL and 125I seeds- by conducting a national survey developed by the Working Group on Radioguided Surgery (GTCRG) of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM). Material and methods: In October 2020, the form was sent in digital format to the different nuclear medicine services in Spain. A response time of 2months with an overtime of 15 days was given. The number of ROLL/SNOLL procedures in each centre and the methodology used were obtained, including important technical details. In addition, a specific section on 125I seeds was included. The results were automatically downloaded into an Excel 2007 spreadsheet for subsequent analysis with the same program. Results: The survey was answered by 55 centres; 21 use wire-guided localisation while the remaining 34 use different radioguided surgery techniques (RGS) for the localisation of non-palpable breast lesions, with the results itemized into thirteen sections. The commonly used tracer dose is 111 MBq for the ROLL technique and 222 MBq for the SNOLL technique, with a volume of 0.2ml. The most common protocol is the two-day protocol. 26% of centres performing CRG use 125I seeds for both breast lesion and suspicious/pathological node detection, with the time between implantation and removal being about 3 days, with subsequent radiological control in most cases. Conclusion: The survey shows the relevance of radioguided surgery in the management of breast cancer patients at different stages of the disease, with disparity in the implementation of new techniques and tools, which responds to the multiple healthcare realities of Nuclear Medicine services (AU)

Humanos , Feminino , Neoplasias da Mama/cirurgia , Neoplasias da Mama/diagnóstico , Medicina Nuclear , Biópsia de Linfonodo Sentinela , Cirurgia Assistida por Computador , Pesquisas sobre Atenção à Saúde , Radioisótopos do Iodo , Imagem Molecular , Sociedades Médicas , Espanha
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 48(5): 323-333, Jul. - Ago. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-205249


Objetivo: Describir cómo se aborda la sexualidad en las consultas de los médicos de familia (MF), así como comparar los resultados de un cuestionario realizado en 2017, que actualizó los datos obtenidos de una encuesta de 2004. Material y métodos: Estudio descriptivo, analítico, multicéntrico con 2cortes transversales. De los 3.500 MF que cumplían los criterios selección (acreditación como tutor de residentes y ser trabajador en activo en el momento del estudio), contestaron a la encuesta 598 médicos en 2017 y 357 en 2004. Resultados: En ambos estudios la mayoría (98,6% en 2017 y 96% en 2004) considera que la esfera sexual es un componente importante en la salud de las personas, pero menos de la mitad (40,6% en 2017 y 21,6% en 2004) lo registra sistemáticamente en su historia clínica. Los cursos de formación continuada fueron la principal fuente de formación en sexualidad en ambos estudios (50,6% en 2017 y 31,4% en 2004). Las principales barreras encontradas en ambos estudios fueron la falta de tiempo (85,5% en 2017 y 82,1% en 2004) y la falta de formación (75,2% en 2017 y 74,5% en 2004). Conclusiones: Los MF conocen la importancia de la sexualidad en la salud de las personas, pese a ello, un escaso número de profesionales lo registra sistemáticamente en su historia clínica. Los cursos de formación continuada fueron una fuente formación en sexualidad muy relevante y coincide con un aumento de su oferta en los últimos años. Las principales barreras en ambos estudios fueron la falta de tiempo y la escasa formación (AU)

Objective: To describe how sexuality is addressed in general practitioners’ (GP) consultations, as well as to compare the results of a questionnaire carried out in 2017 that updated the data obtained from a 2004 survey. Material and methods: Descriptive, analytical, multicentre study with 2cross-sections. Of the 3,500 GP who met the selection criteria (holding current accreditation as a resident tutor and being an active worker at the time of the study), 598 doctors participated in the survey in 2017 and 357 in 2004. Results: In both studies, the majority (98.6% in 2017 and 96% in 2004) consider that the sexual sphere is an important component in people's health, but less than half (40, 6% in 2017 and 21.6% in 2004) systematically recorded it in their clinical history. The main source of training in sexuality in both studies were continuing education courses (50.6% in 2017 and 31.4% in 2004). The main barriers found in both studies were lack of time (85.5% in 2017 and 82.1% in 2004) and lack of training (75.2% in 2017 and 74.5% in 2004). Conclusions: GP are aware of the importance of sexuality in people's health, despite this, few professionals systematically record it in their medical records. The main source of training in sexuality is continuing education courses, which has increased in recent years. The main barriers in both studies are lack of time and poor training (AU)

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Encaminhamento e Consulta , Comportamento Sexual , Sexualidade , Estudos Transversais , Espanha
Rev. esp. quimioter ; 35(4): 333-343, ag. - sept. 2022.
Artigo em Inglês | IBECS | ID: ibc-205379


The incidence of COVID in pediatrics was underestimated during the first months of the pandemic due to the oligosymptomatic nature of the infection in many children and thescarcity of diagnostic tests applied to this population. It is nowaccepted that children are infected and transmit the diseasein the same way as adults. On the contrary, children have lesssevere and less lethal COVID, probably due to a lower maturityof the child’s immune system, a lower number of ACE2 receptors and the lower presence of comorbidities in this populationgroup.The development of a multisystemic inflammatory syndrome after SARS-CoV-2 infection in children, despite its rarity, is a very serious condition that frequently requires intensivecare. Other less severe post-COVID manifestations have beendescribed in children but are not yet well defined.COVID has had and continues to have a significant psychological impact on the children themselves, on their caregiversand on the exacerbation of pre-existing psychiatric conditions.We apply adult therapeutic principles to children but withvery low levels of evidence. Information on the tolerability of the available medications in this population group is stillscarce. The mortality of COVID in children is very low and generally affects children with significant comorbidities.There are, at present, three vaccines licensed for pediatricuse which are compatible with all other vaccines applicable tochildren.In these circumstances, there has been much speculationabout the indication for vaccination in the pediatric age group,but given its good tolerance, there are clinical and ethical reasons that, in our opinion, justify it. (AU)

La incidencia de COVID en pediatría ha estado infraestimada durante los primeros meses de la pandemia por el carácter oligosintomático de la infección en muchos niños y porla escasez de pruebas diagnósticas aplicadas a esta población.Hoy se admite que los niños se infectan y transmiten la enfermedad igual que los adultos. Por el contrario, los niños tienencuadros clínicos menos graves y letales lo cuál parece relacionado con una menor madurez del sistema inmune del niño,una menor cantidad de receptores ACE2 y la menor presenciade comorbilidades en este grupo de población.El desarrollo de un síndrome inflamatorio multisistémicotras la infección por SARS-CoV-2 en niños, pese a su rareza, esun cuadro muy grave que frecuentemente requiere cuidadosintensivos. Se han descrito otros cuadros post-COVID en niños,menos graves, pero todavía no muy bien definidos.La COVID-19 ha tenido y tiene un importante impacto psicológico en los propios niños, en sus cuidadores y en la exacerbación de cuadros psiquiátricos pre-existentes.Aplicamos a los niños los principios terapéuticos de losadultos pero con niveles muy bajos de evidencia y la toleranciade los medicamentos disponibles en este grupo de poblaciónes todavía mal conocida. La mortalidad de la COVID en niñoses muy baja e incide generalmente en niños con importantescomorbilidades.Hay, en el momento presente, tres vacunas autorizadaspara el uso pediátrico y las vacunas frente a SARS-CoV-2 soncompatibles con el resto de las vacunas aplicables a niños.En estas circunstancias se ha especulado mucho sobre laindicación de vacunación en la edad pediátrica pero dada subuena tolerancia, existen, en nuestra opinión, razones clínicasy éticas que la justifican. (AU)

Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Pandemias , Infecções por Coronavirus/epidemiologia , Pediatria , Vacinação em Massa , Infecções por Coronavirus/tratamento farmacológico , Espanha
Rev. esp. quimioter ; 35(4): 392-400, ag. - sept. 2022. tab
Artigo em Inglês | IBECS | ID: ibc-205386


Objective. To measure the impact of the pandemic inSpanish ICUs.Material and methods. On-line survey, conducted inApril 2021, among SEMICYUC members. Participants wereasked about number of patients admitted, increase in thenumber of beds and staff, structures created in the hospitaland self-assessment of the work performed.Results. We received 246 answers from 157 hospitals.67.7% of the ICUs were expanded during the pandemic, overall increase in beds of 58.6%. The ICU medical staff increasedby 6.1% and there has been a nursing shortage in 93.7% ofunits. Patients exceeded 200% the pre-pandemic ICU capacity.In 88% of the hospitals the collaboration of other specialistswas necessary. The predominant collaboration model consisted of the intensive care medicine specialist being responsiblefor triage and coordinating patient management. Despite that53.2% centres offered training for critical care, a deteriorationin the quality of care was perceived. 84.2% hospitals drew upa Contingency Plan and in 77.8% of the hospitals a multidisciplinary committee was set up to agree on decision-making.Self-evaluation of the work performed was outstandingand 91.9% felt proud of what they had achieved, however, upto 15% considered leaving their job.Conclusions. The Spanish ICUs assumed an unprecedented increase in the number of patients. They achieved it withouthardly increasing their staff and, while intensive care medicinetraining was carried out for other specialists who collaborated.The degree of job satisfaction was consistent with pre-pandemic levels. (AU)

Objetivo. Medir el impacto de la pandemia COVID-19 en las UCI españolas. Material y métodos. Cuestionario online, realizado en abril 2021 entre socios de SEMICYUC. Se interrogó acerca delnúmero de pacientes ingresados, incremento en número decamas y personal, estructuras creadas en el hospital y autoevaluación del trabajo realizado.Resultados. Recibimos 246 respuestas de 157 hospitales. El 67.7% de las UCI se expandieron durante la pandemia,con un incremento de camas del 58.6%. El personal médicode las UCI aumentó un 6.1% y hubo escasez de enfermería enel 93.7% de las unidades. Los pacientes excedieron un 200%la capacidad pre-pandemia y en el 88% de los hospitales fuenecesaria la colaboración de otros especialistas, siendo elmodelo predominante aquel en que el especialista en medicina intensiva era responsable del triaje y coordinaba el tratamiento del paciente. A pesar de que en el 53.2% de los centros se ofreció formación en medicina intensiva se detectó undeterioro de la calidad asistencial. El 84.2% de los hospitaleselaboraron un plan de contingencia y el 77.8% conformaronun comité multidisciplinar para consensuar decisiones. Laevaluación del trabajo fue sobresaliente y el 91.9% se sienteorgulloso del resultado, pero hasta el 15% consideró abandonar la especialidad.Conclusiones. Las UCI españolas asumieron un incremento de pacientes sin precedentes, sin apenas aumento delpersonal y mientras formaban a otros especialistas que colaboraron. El grado de satisfacción con el trabajo realizado fuesimilar al pre-pandemia. (AU)

Humanos , Pandemias , Infecções por Coronavirus/epidemiologia , Unidades de Terapia Intensiva , Inquéritos e Questionários , Espanha
Rev. esp. enferm. dig ; 114(8): 474-480, agosto 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-205704


Objectives: The aim of this study was to analyze the trends of pancreatic cancer mortality in Spain from 1955-2020 in both genders and every age group, in order to describe the changes in the prevalence of some risk factors and their possible influence on mortality.Methods: Direct standardized mortality rates were calculated using the World Standard Population 2000-2025 and Joinpoint analysis was performed for age-specific and age-standardized mortality trends for the period from 1955-2020.Results: Mortality rates increased with age in both genders, with a marked increase in older groups. During 2020, 71.5% of male deaths and 81.5% of female deaths from pancreatic cancer occurred among those aged 65 years or more. Spanish National Health Surveys since 1987 show decreasing trends in daily smoking, but striking increases in obesity and diabetes mellitus rates in both genders, and rates of daily smoking and obesity are remarkably higher among disadvantaged social classes.Conclusions: Pancreatic cancer mortality rates have increased uninterruptedly in Spain during the last decades. Increasing trends in obesity and diabetes mellitus, particularly among males, and the different prevalence of obesity and smoking according to social class are public health problems of great concern. Smoking and obesity are potentially avoidable risk factors. Thus, educational programs and legislative measures should be implemented more widely, such as programs for smoking prevention, healthy nutrition and physical exercise, and would be applied more intensively in the most disadvantaged social classes. (AU)

Humanos , Obesidade/epidemiologia , Neoplasias Pancreáticas , Tabagismo/epidemiologia , Fatores de Risco , Espanha/epidemiologia
Aten. prim. (Barc., Ed. impr.) ; 54(8): 102413, Ago 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-205895


Objectives: To determine the epidemiology of heart failure registered in primary healthcare clinical records in Catalunya, Spain, between 2010 and 2014, focusing on incidence, mortality, and resource utilization. Design: Retrospective observational cohort study. Setting: Study was carried out in primary care setting. Participants and interventions: Patients registered as presenting a new heart failure diagnosis. The inclusion period ran from 1st January 2010 to 31st December 2013, but patients were followed until 31st December 2013 in order to analyze mortality. Main measures: Information came from electronic medical records. Results: A total of 64441 patients were registered with a new diagnosis of heart failure (2.76 new cases per 1000 persons-year). Among them, 85.8% were ≥65 years. The number of cases/1000 persons-year was higher in men in all age groups. Incidence ranged from 0.04 in women <45 years to 27.61 in the oldest group, and from 0.08 in men <45 years to 28.52 in the oldest group. Mortality occurred in 16305 (25.3%) patients. Primary healthcare resource utilization increased after the occurrence of heart failure, especially the number of visits made by nurses to the patients’ homes. Conclusion: Heart failure incidence increases with age, is greater in men, and remains stable. Mortality continues to be high in newly diagnosed patients in spite of the current improvements in treatment. Home visits represent the greatest cost for the management of this disease in primary care setting.(AU)

Objetivo: Determinar la epidemiología de la insuficiencia cardíaca registrada en las historias clínicas de atención primaria en Cataluña, España, entre 2010 y 2014, centrándose en la incidencia, la mortalidad y la utilización de recursos sanitarios. Diseño: Estudio de cohorte observacional retrospectivo. Emplazamiento: El estudio se llevó a cabo en atención primaria. Participantes e intervenciones: Pacientes registrados con nuevo diagnóstico de insuficiencia cardíaca en el período de estudio. El período de inclusión fue del 1 de enero de 2010 al 31 de diciembre de 2013, pero los pacientes se siguieron hasta el 31 de diciembre de 2014 para poder determinar la mortalidad. Mediciones principales: La información se obtuvo de la historia clínica electrónica de los participantes. Resultados: Se registraron un total de 64.441 pacientes con nuevo diagnóstico de insuficiencia cardíaca (2,76 nuevos casos/1000 personas-año). De ellos, el 85,8% tenían ≥65 años. El número de casos/1000 personas-año fue mayor en hombres en todos los grupos de edad. La incidencia varió de 0,04 en mujeres <45 años a 27,61 en el grupo de mayor edad, y de 0,08 en hombres <45 años a 28,52 en el grupo de mayor edad. La mortalidad se produjo en 16.305 (25,3%) pacientes. La utilización de los recursos de atención primaria aumentó tras el diagnóstico de insuficiencia cardíaca, especialmente el número de visitas realizadas por las enfermeras a los pacientes en su domicilio. Conclusión: La incidencia de insuficiencia cardíaca aumenta con la edad, es mayor en hombres y se mantiene estable en el tiempo. La mortalidad continúa siendo alta en pacientes recién diagnosticados a pesar de las mejoras actuales en el tratamiento. Las visitas domiciliarias representan el mayor coste para el manejo de esta enfermedad en el ámbito de atención primaria.(AU)

Humanos , Masculino , Feminino , Insuficiência Cardíaca , Insuficiência Cardíaca/epidemiologia , Registros Médicos , Recursos em Saúde , Incidência , Registros Eletrônicos de Saúde , Atenção Primária à Saúde , Espanha , Estudos de Coortes , Estudos Retrospectivos
Aten. prim. (Barc., Ed. impr.) ; 54(8): 102362, Ago 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-205897


Objetivo: Aunque se dispone de mejores diagnósticos y tratamientos, la insuficiencia cardíaca (IC) es una causa importante de muerte en España. El objetivo de este estudio es describir el tratamiento y las características de la población con IC crónica, clasificada según la fracción de eyección del ventrículo izquierdo (FEVI). Diseño: Estudio observacional de cohortes de base poblacional en atención primaria (AP). Emplazamiento: Cataluña, 2014-2018. Participantes: Se incluyeron pacientes adultos con diagnóstico incidente de IC clasificada según la FEVI. Intervención: Análisis de los datos de salud registrados en la base de datos Sistema de Información para el Desarrollo de la Investigación en AP (SIDIAP). Variables principales: Demográficas, FEVI, comorbilidades y uso de fármacos para la IC. Resultados: Se incluyeron 10.130 pacientes; el 18,9% con FEVI<40 (ICFEr), el 15,9% con FEVI 40-49 (ICFEi) y el 65,2% con FEVI≥50 (ICFEp), este último grupo con mayor proporción de mujeres (57,5%) y una mayor edad media (80,2 años). La población con ICFEi era similar a la de ICFEr en edad, género, comorbilidades o tratamiento. Las comorbilidades más frecuentes eran la hipertensión (78.3%), la dislipemia (54%) y la fibrilación auricular (41,5%). Los tratamientos más frecuentes fueron los β-bloqueantes, con diferencias según la FEVI (FEVIr 1.515 [79,2%], FEVIi 1.142 [70,8%] y FEVIp 3.371 [51,0%]), seguido de los diuréticos de asa (65,7%). Conclusiones: El tratamiento farmacológico de la IC varía en función de la FEVI. El tratamiento y las características poblacionales de los pacientes con ICFEi son similares a aquellos con ICFEr.(AU)

Despite better diagnoses and treatments, heart failure (HF) is an important cause of death in Spain. The objective of this study is to describe the characteristics and treatment of a population with chronic HF classified according to the left ventricular ejection fraction (LVEF). Population-based observational cohort study in Primary Health Care. Catalonia, Spain, during 2014–2018. Adults with HF classified by the LVEF. Analysis of electronic health data registered in SIDIAP (Information System for Research in Primary Care). Demographics, LVEF, comorbidities, and use of drugs for HF. 10,130 patients were included; 18.9% with LVEF<40 (HFrEF), 15.9% with LVEF 40-49 (HFmEF) and 65.2% with LVEF≥50 (HFpEF), this last group with a higher proportion of women (57.5%) and higher mean age (80.2 years-old). People with HFmEF were similar to those with HFrEF in age, gender, comorbidities and treatment. The most frequent comorbidities were hypertension (78.3%), dyslipidaemia (54%) and atrial fibrillation (41.5%). The most frequent pharmacological treatments were β blockers with differences according to the LVEF [HFrEF 1515 (79.2%), HFmEF 1142 (70.8%) and HFpEF 3371 (51%)], followed by loop diuretics (65.7%). HF is a prevalent disease. Having information on LVEF could guide its pharmacological management. The HF population has persistent cardiovascular risk factors and habits. Treatment and population characteristics of patients with HFmEF are similar to those with HFrEF.(AU)

Humanos , Masculino , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Primeiros Socorros , Função Ventricular , Tratamento Farmacológico , Registros Eletrônicos de Saúde , Estudos de Coortes , Atenção Primária à Saúde , Espanha