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Vol. 29, nº 28. Anisakis simplex en comidas preparadas a base de productos de la pesca.
No full textEnfermedades de Declaración Obligatoria por provincias. Semana 27/2024 y acumulado desde la semana 01/2024. Datos provisionales. Incluye además el artículo titulado “Anisakis simplex en comidas preparadas a base de productos de la pesca”, de Antonio Garrido Estrella, jefe del Servicio de Salud de la Delegación Territorial de Almería.N
Evolution of the risk of death and hospitalisation in drivers involved in road crashes in spain, 1993-2020: an age-period-cohort analysis.
No full textBackground: A prerequisite for understanding temporal changes in road crash severity is an unbiased description of this phenomenon. The aim of this study was to estimate the independent association trends of age, period and cohort with severity, encompassing the risk of death (RD) and the risk of death or hospitalisation (RDH) within 24 h, for drivers of passenger cars involved in road crashes with casualties in Spain from 1993 to 2020.
Methods: The study population comprised 2,453,911 drivers of passenger cars aged 18 to 98 years involved in road crashes included in the registers of the General Directorate of Traffic. Crash- and driver-related variables with sufficient continuity over time were included, establishing RD and RDH as study outcomes. Temporal trends of both outcomes were analysed using multivariable Poisson regression and multivariable age-period-cohort intrinsic estimator models. An additional sensitivity analysis was performed for the subset of single crashes.
Results: Severity estimates showed some variation across strategies. The APC model identified: (1) a J-shaped pattern for the effect of age on severity, (2) a decline in severity between 2001 and 2004 and 2013-2016, and (3) a birth cohort effect for both RD and RDH. In particular, the 1952-1958 cohort had the highest risk (RD = 1.17; 95%CI = 1.11-1.24 and RDH = 1.16; 95%CI = 1.13-1.19), followed by a decreasing trend in subsequent cohorts. Restricting the analysis to single crashes yielded similar results, with the exception of the age effect (severity increased with age). Furthermore, sex differences were observed-female sex was inversely associated with severity, especially for RD.
Conclusions: RD and RDH decreased during the first decade of the 21st century, but seemed to stabilise from 2013 onwards. Evidence from this study support that birth cohort is associated with road crash severity, independent of age and period. This cohort effect might be due, at least partially, to improvements in general and road safety education. Further studies are needed to elucidate the causes of our findings and to identify factors accounting for sex differences.Ye
Vol. 29, nº 37. Brote de intoxicación alimentaria por toxina de Clostridium perfringens dado en un establecimiento público alimentario de Granada, 2024.
No full textEnfermedades de Declaración Obligatoria por provincias. Semana 36/2024 y acumulado desde la semana 01/2024. Datos provisionales. Incluye además el artículo titulado “Brote de intoxicación alimentaria por toxina de Clostridium perfringens dado en un establecimiento público alimentario de Granada, 2024”, de “Elvira Marín Caba, Diego Almagro Nievas, María Angustias Barcelona Sánchez”.N
Vaccination strategies for patients under monoclonal antibody and other biological treatments: an updated comprehensive review based on EMA authorisations to January 2024.
No full textIntroduction: Monoclonal antibodies (mAbs) and other biological agents are being increasingly approved in the last years with very different indications. Their highly heterogeneous immunosuppressive effects, mechanisms of action and pharmacokinetics require comprehensive individualized vaccination schedules.
Areas covered: Vaccination for immunocompromised patients. Prevention and treatment with mAbs and other biological therapies.
Expert opinion: Current recommendations on vaccine schedules for patients under mAbs or other biological treatments are based on expert opinions and are not individualized according to each vaccine and treatment. No studies are focusing on the high heterogeneity of these agents, which are exponentially developed and used for many different indications. Recent paradigm changes in vaccine development (boosted by the COVID-19 pandemic) and in the mAbs use for prophylactic purposes (changing 'vaccination' by 'immunization' schedules) has been witnessed in the last years. We aimed at collecting all mAbs used for treatment or prevention, approved as of 1 January 2024, by the EMA. Based on available data on mAbs and vaccines, we propose a comprehensive guide for personalizing vaccination. Recent vaccine developments and current population strategies (e.g. zoster vaccination or prophylactic nirsevimab) are discussed. This review aims to be a practical guideline for professionals working in vaccine consultations for immunosuppressed patients.Ye
Surgical Treatment in Post-Stroke Spastic Hands: A Systematic Review.
No full textFor more than two decades, the surgical treatment of post-stroke spastic hands has been displaced by botulinum toxin therapy and is currently underutilized. : This article aimed to assess the potential of surgery for treating a post-stroke spastic upper extremity through a systematic review of the literature on surgical approaches that are adopted in different profiles of patients and on their outcomes and complications. : Medline PubMed, Web of Science, SCOPUS, and Cochrane Library databases were searched for observational and experimental studies published in English up to November 2022. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) system. : The search retrieved 501 abstracts, and 22 articles were finally selected. The GRADE-assessed quality of evidence was low or very low. The results of the reviewed studies suggest that surgery is a useful, safe, and enduring treatment for post-stroke spastic upper extremities, although most studied patients were candidates for hygienic improvements alone. Patients usually require an individualized combination of techniques. Over the past ten years, interest has grown in procedures that act on the peripheral nerve. : Despite the lack of comparative studies on the effectiveness, safety, and cost of the treatments, botulinum toxin has displaced surgery for these patients. Studies to date have found surgery to be an effective and safe approach, but their weak design yields only poor-quality evidence, and clinical trials are warranted to compare these treatment options.Ye
SEOM-GEMCAD-TTD clinical guidelines for the adjuvant treatment of colon cancer (2023)
No full textColorectal cancer (CRC) has a 5-year overall survival rate of over 60%. The decrease in the rate of metastatic disease is due to screening programs and the population's awareness of healthy lifestyle. Similarly, advancements in surgical methods and the use of adjuvant chemotherapy have contributed to a decrease in the recurrence of resected disease. Before evaluating a patient's treatment, it is recommended to be discussed in a multidisciplinary tumor board. In stage II tumors, the pathologic characteristics of poor prognosis must be known (T4, number of lymph nodes analyzed less than 12, lymphovascular or perineural invasion, obstruction or perforation, poor histologic grade, presence of tumor budding) and it is mandatory to determine the MSI/MMR status for avoiding administering fluoropyridimidines in monotherapy to patients with MSI-H/dMMR tumors. In stage III tumors, the standard treatment consists of a combination of fluoropyrimidine (oral or intravenous) with oxaliplatin for 6 months although the administration of CAPOX can be considered for 3 months in low-risk tumors. Neoadjuvant treatment is not consolidated yet although immunotherapy is achieving very good preliminary results in MSI-H patients. The use of ctDNA to define the treatment and monitoring of resected tumors is only recommended within studies. These guidelines are intended to help decision-making to offer the best management of patients with non-metastatic colon cancer.Ye
Competencias de los Profesionales Sanitarios en el Marco de la Complejidad: Modelo de Formación Digital para la Educación 4.0
No full textEn entornos complejos, los profesionales sanitarios necesitan adaptar sus modelos de formación para acceder al conocimiento y tomar decisiones en la docencia y la investigación clínica. Esto implica desarrollar competencias digitales para aprovechar el ecosistema sanitario digital y mantener un aprendizaje continuo. Con el objetivo de analizar los hábitos de uso de los recursos de información por parte de los sanitarios y proponer un modelo de formación en competencia digital, se llevó a cabo una investigación exploratoria y explicativa. Los datos se recopilaron mediante cuestionarios en actividades formativas. El programa diseñado para desarrollar estas competencias digitales fue bien recibido por los usuarios, quienes valoraron positivamente los contenidos, recursos y docentes, considerándolo efectivo. La formación en competencias digitales es crucial para la transformación digital en el campo de la salud. Los entornos virtuales de enseñanza-aprendizaje también plantean desafíos para las bibliotecas en el siglo XXI.Complex environments require changes in training models for health professionals to support access to knowledge for teaching and clinical research decision-making. These changes require digital competency training to successfully address knowledge acquisition and lifelong learning in the digital health ecosystem. This research aims to analyse the habits of use of information resources by healthcare professionals in professional practices and to propose a model for training in digital competence. An exploratory and explanatory research method was chosen. Data collection techniques included pre-test and post-test questionnaires for the training activities. The program designed to develop digital competency under the model proposed in this study had significant acceptance among users who valued all the contents, resources, and teachers and considered it effective. Training in digital competencies is one of the drivers of digital transformation. Teaching-learning models in virtual environments pose challenges for 21st-century libraries.Universidad de Salamanca, EspañaTechnologico de Monterrey, MexicoYe
Vol. 29, nº 42. Brote de salmonelosis en un establecimiento público alimentario de Granada. Junio 2023
No full textEnfermedades de Declaración Obligatoria por provincias. Semana 41/2024 y acumulado desde la semana 01/2024. Datos provisionales. Incluye además el artículo titulado “Brote de salmonelosis en un establecimiento público alimentario de Granada. Junio 2023”, de “Martín-Pérez FJ, Castilla-Heredia JP, Pérez-de Rojas J, Gómez-Pozo B, Almagro-Nievas D”.N
Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study.
No full textBackground and objective
Reducing patient decision delay – the time elapsed between symptom onset and the moment the patient decides to seek medical attention – can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters.
Methods
We developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution.
Results
Patient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay.
Discussion
The diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.Ye
For, against, and beyond: healthcare professionals' positions on Medical Assistance in Dying in Spain.
No full textBackground
In 2021, Spain became the first Southern European country to grant and provide the right to euthanasia and medically assisted suicide. According to the law, the State has the obligation to ensure its access through the health services, which means that healthcare professionals’ participation is crucial. Nevertheless, its implementation has been uneven. Our research focuses on understanding possible ethical conflicts that shape different positions towards the practice of Medical Assistance in Dying, on identifying which core ideas may be underlying them, and on suggesting possible reasons for this disparity. The knowledge acquired contributes to understanding its complexity, shedding light into ambivalent profiles and creating strategies to increase their participation.
Methods
We conducted an exploratory qualitative research study by means of semi-structured interviews (1 h) with 25 physicians and nurses from primary care (12), hospital care (7), and palliative care (6), 17 women and 8 men, recruited from Madrid, Catalonia, and Andalusia between March and May 2023. Interviews were recorded, transcribed, and coded in Atlas.ti software by means of thematic and interpretative methods to develop a conceptual model.
Results
We identified four approaches to MAiD: Full Support (FS), Conditioned Support (CS), Conditioned Rejection (CR), and Full Rejection (FR). Full Support and Full Rejection fitted the traditional for and against positions on MAiD. Nevertheless, there was a gray area in between represented by conditioned profiles, whose participation cannot be predicted beforehand. The profiles were differentiated considering their different interpretations of four core ideas: end-of-life care, religion, professional duty/deontology, and patient autonomy. These ideas can intersect, which means that participants' positions are multicausal and complex. Divergences between profiles can be explained by different sources of moral authority used in their moral reasoning and their individualistic or relational approach to autonomy.
Conclusions
There is ultimately no agreement but rather a coexistence of plural moral perspectives regarding MAiD among healthcare professionals. Comprehending which cases are especially difficult to evaluate or which aspects of the law are not easy to interpret will help in developing new strategies, clarifying the legal framework, or guiding moral reasoning and education with the aim of reducing unpredictable non-participations in MAID.Ye