Focus on Suicidal Behaviours - The experience of the11th EPA Summer School

Every year, the European Psychiatric Association organizes the EPA Summer School, an intensive program that aims to support and promote the education of young psychiatry professionals through numerous activities. The program returned to being an in-person event this year, after changes imposed by the COVID-19 pandemic over the last two years. From September 29 to October 2, 2022, young psychiatrists selected by the EPA Committee on Education, 21 in total, gathered together in Strasbourg, France, to attend the activities organized around the topic "Focus on Suicidal Behaviours - One Step Beyond." This year's event adopted a blended learning format;the participants were required to attend and complete a 6-week online course entitled "Focus on Suicidal Behaviours", before coming to the in-person sessions held by a distinguished group of lecturers. The activities designed during the training days allowed the participants to not only expand their knowledge about suicide and related issues but also to exchange experiences from different European countries, and they encouraged critical thinking about what can be done more or better. In addition, they encouraged the participants to get to know each other, to socialize, and to building relationships with each other. This article presents step-by-step the activities organized during the Summer School and also attempts to describe the way the participants experienced them. © 2023 John Libbey Eurotext. All rights reserved.;Chaque année, l'Association Européenne de Psychiatrie organise une Université d'été, un programme intensif qui vise à soutenir et à promouvoir l'éducation des jeunes professionnels de la psychiatrie par le biais de nombreuses activités. Elle a pu se tenir de nouveau en présentiel en 2022, après 2 ans d'organisation en distanciel, imposée par la pandémie de covid-19. Du 29 septembre au 2 octobre 2022, les jeunes psychiatres sélectionnés par le Comité d'éducation de l'EPA, 21 au total, se sont retrouvés à Strasbourg, en France, pour assister à cette formation autour du thème « Focus sur les conduites suicidaires - One step beyond ». L'événement de cette année a été que le format était un enseignement mixte. Pour débuter, la 1re partie de la formation s'est déroulée en ligne, sous la forme d'un MOOC « Focus sur les comportements suicidaires », pour une durée de 6 semaines, la seconde partie était la formation en présentiel avec des experts internationaux, sur une durée de 2 jours 1/2. Ces journées de formation ont permis aux participants non seulement d'élargir leurs connaissances sur le suicide et les questions connexes, mais aussi d'échanger autour des expériences de différents pays européens et d'encourager la réflexion critique sur ce qui peut être fait de plus ou de mieux, en termes de prévention et de soins. De plus, la possibilité de rencontres et d'échanges entre les participants a permis la création d'un réseau social européen unique. Cet article présente étape par étape les activités de formation organisées pendant l'université d'été de l'EPA et témoigne du vécu des participants. © 2023 John Libbey Eurotext. All rights reserved.;Cada año, la Asociación Europea de Psiquiatría organiza una Escuela de Verano, un programa intensivo cuyo objetivo es apoyar y promover la formación de jóvenes profesionales de la psiquiatría a través de una gran variedad de actividades. Ha podido volver a celebrarse en persona en 2022, tras 2 años de organización a distancia, impuesta por la pandemia de la covid-19. Del 29 de septiembre al 2 de octubre de 2022, los jóvenes psiquiatras seleccionados por el Comité de Educación de la EPA, 21 en total, se reunieron en Estrasburgo (Francia) para asistir a esta formación sobre el tema "Enfoque en las conductas suicida - One step beyond (Un paso más allá"). Lo más destacado del acto de este año fue que el formato era una formación combinada. Para empezar, la 1a parte de la formación fue online, en forma de MOOC "Focus en conductas suicidas", con un duración de 6 semanas, la segunda parte fue la formación presencial con expertos internacionales, con una duración de 2 días y medio. Estas jornadas de formación les permitieron a los participantes no sólo ampliar sus conocimientos sobre el suicidio y cuestiones afines, sino también intercambiar en torno a experiencias de distintos países europeos y fomentar el pensamiento crítico sobre qué más o mejor se puede hacer, en términos de prevención y asistencia. Además, la posibilidad de encuentros e intercambios entre los participantes permitió crear una red social europea única. Este artículo presenta paso a paso las actividades de formación organizadas durante la escuela de verano de la EPA y da fe de la experiencia de los participantes. © 2023, John Libbey Eurotext. Tous droits réservés. © 2023 John Libbey Eurotext. All rights reserved.

Evidencia sobre estrategias de prevención y rehabilitación del síndrome post-UCI en adultos: una revisión de revisiones sistemáticas

Resumen Introducción El síndrome post-UCI (PICS, por sus siglas en inglés) es un síndrome que cada vez más cobra importancia debido al creciente número de pacientes sobrevivientes a la enfermedad crítica, fenómeno que se ha visto acentuado especialmente luego de la pandemia del COVID-19. El enfoque de la práctica médica que atiende a estos pacientes debe estar orientado en las mejores intervenciones disponibles para prevenir y rehabilitar las secuelas del PICS. Objetivo Sintetizar la evidencia sobre la eficacia y la efectividad de las estrategias para la prevención y rehabilitación del PICS en pacientes adultos. Métodos Revisión de revisiones sistemáticas (CRD42022321610). Se buscaron en PubMed, Scopus, Ovid (Cochrane) y LILACS las revisiones sistemáticas que evaluaran cualquier intervención para prevenir o rehabilitar el PICS y su efecto en algunas de las esferas del PICS (es decir, desenlaces mentales, cognitivos o físicos). Resultados Se incluyeron 20 estudios, 10 catalogados como de baja y muy baja calidad metodológica, por lo que no se incluyeron en la síntesis de resultados. Las terapias a nivel de las esferas mental y cognitiva parecen tener un efecto benéfico, pero con evidencia limitada. Las intervenciones analizadas en la esfera física son muy heterogéneas y tienen resultados contradictorios, igualmente con calidad de evidencia muy limitada. Conclusiones Teniendo en cuenta las revisiones sistemáticas incluidas en este trabajo, esta investigación permite concluir que hay información de baja calidad y contradictoria sobre la eficacia de las intervenciones para la prevención o rehabilitación del PICS. La práctica futura debe centrarse en desarrollar estudios de alta calidad. Introduction Post-ICU syndrome (PICS) is a syndrome that is becoming increasingly important due to the growing number of patients surviving critical illness, a phenomenon that has been accentuated especially after the COVID-19 pandemic. The focus of the medical practice that cares for these patients should be oriented toward the best available interventions to prevent and rehabilitate the sequelae of PICS. Objective To synthesize the evidence on the efficacy and effectiveness of strategies for preventing and rehabilitating PICS in adult patients. Methods Umbrella review (CRD42022321610). PubMed, Scopus, Ovid (Cochrane), and LILACS were searched for systematic reviews evaluating any intervention to prevent or rehabilitate PICS and its effect on any of the PICS domain(s) (i.e., mental, cognitive, or physical outcomes). Results 20 studies were included, and 10were classified as of low or very-low methodological quality, so they were not included in the summary of results. Therapies at the mental and cognitive levels seem to have a beneficial effect but with limited evidence. The interventions analyzed in the physical sphere are very heterogeneous and have contradictory results, with little quality of evidence. Conclusions Considering the systematic reviews included in this work, this research allows us to conclude that there is low-quality and contradictory information on the efficacy of interventions for the prevention or rehabilitation of PICS. Future practice should focus on developing high- quality studies.

Collaboration between the National Association of Cardiologists of Mexico, the Mexican Society of Cardiology, and the University of Guanajuato. COVID-19 and Cardiac Imaging Personnel: Review of Sanitary Practices in Early 2021 / Colaboración de la Asociación Nacional de Cardiólogos de México y de la Sociedad Mexicana de Cardiología con la Universidad de Guanajuato. COVID-19 y personal de imagen cardiaca: Revisión de prácticas sanitarias al inicio de 2021

The authors of the image chapters of the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC), as well as personnel from the Department of Medicine and Nutrition of the University of Guanajuato, together with prominent experts in cardiovascular imaging from Mexico, have collaborated in the review, analysis and expansion of the various health strategies published in the first year of the coronavirus disease 2019 (COVID-19) pandemic, to safely perform cardiac imaging studies. This update aims to reduce the risk of COVID-19 transmission among patients and health-care personnel in the CT, MRI, and nuclear cardiology services. This work was expanded with supplementary information available free of charge on the website www.ancam-imagen.com.

Los capítulos de imagen de la Asociación Nacional de Cardiólogos de México (ANCAM) y de la Sociedad Mexicana de Cardiología (SMC), así como personal del Departamento de Medicina y Nutrición de la Universidad de Guanajuato, en conjunto con destacados expertos de la imagen cardiovascular en México, han colaborado en la revisión, análisis y ampliación de las diversas estrategias sanitarias publicadas en los primeros 15 meses de la pandemia de enfermedad por coronavirus 2019 (COVID-19) para realizar con seguridad los estudios de imagen cardiaca; esta actualización tiene como objetivo principal disminuir el riesgo de transmisión de la COVID-19 entre los pacientes y el personal de salud en los servicios de tomografía, resonancia y cardiología nuclear. Este trabajo se amplió con información suplementaria disponible sin costo en el sitio www.ancam-imagen.com.

Dynamics for the containment of COVID-19 transmission in a city in the interior of Amazonas State / Dinâmica para contenção da transmissão da COVID-19 em um município do interior do Amazonas / Dinámica de contención de la transmisión del COVID-19 en interior del Amazonas

Problema: A pandemia da COVID-19 causada pelo novo coronavírus (SARS-CoV-2) tornou-se um dos maiores desafios de saúde pública deste século. Método: Trata-se de um estudo do tipo relato de experiência, realizado por alunos finalistas dos cursos de Medicina, Enfermagem e Odontologia da Universidade do Estado do Amazonas (UEA), na disciplina de "Estágio rural em saúde coletiva", no município de Itapiranga, estado do Amazonas. A experiência que deu origem a este relato ocorreu nos meses de agosto e setembro de 2020. Resultados: Os alunos foram inseridos nas equipes de saúde da família do município, com as quais desenvolveram atividades como visitas domiciliares, ações educativas em saúde, testes rápidos para COVID-19, visitas a comunidades ribeirinhas, consultas e atendimentos de enfermagem, medicina e odontologia. As medidas de prevenção da COVID-19 no município começaram com a orientação dos profissionais de saúde para o manejo da doença. Uso de máscaras, isolamento social e fechamento do comércio foram algumas providências adotas após o primeiro caso confirmado do vírus, ocorrido no dia 21 de abril de 2020. Foi realizada testagem em massa na população para a detecção dos casos sintomáticos e assintomáticos. Além disso, foram contratados mais profissionais de saúde como médicos, enfermeiros, psicólogos, técnicos de enfermagem e fisioterapeutas a fim de reforçar a equipe de saúde. Conclusão: O estágio rural em saúde coletiva na cidade de Itapiranga representou uma oportunidade ímpar de interação entre os discentes e as equipes de saúde do município, além da possibilidade de se ter uma visão mais ampla da funcionalidade da atenção primária à saúde, principalmente em período pandêmico, quando esse nível de atenção se mostrou tão importante para o diagnóstico precoce da doença quanto para a efetividade das medidas de contenção.

Problem: The COVID-19-CoV pandemic caused by the novel coronavirus (SARS-CoV-2) has become one of the greatest public health challenges of this century. Method: This was an experience report study carried out by final-year students in medicine, nursing and dentistry at Amazonas State University (Universidade do Estado do Amazonas, UEA), in the discipline of "Rural Internship in Collective Health," in the municipality of Itapiranga, state of Amazonas. The experience that prompted the students' report took place in August and September of 2020. Results: The students were included in the municipality's family health teams, with which they developed activities such as visits to riverside communities, consultations, and nursing, medical and dental care. COVID-19 prevention measures in the municipality were implemented with the guidance of health professionals in the management of the disease. The use of masks, social distancing and closing of shops were some measures adopted after the first confirmed case of the virus, which occurred on April 21, 2020. Mass testing was carried out in the population to detect symptomatic and asymptomatic cases. In addition, more health professionals including physicians, nurses, psychologists and nursing technicians were hired to reinforce the health team. Conclusion: The Rural Internship in Collective Health in Itapiranga represented a unique opportunity for interaction between students and the health teams in the municipality, and made it possible for students to have a broader view of the functioning of primary health care, especially in a pandemic period, when the level of care proved to be as important for early diagnosis of the disease as for the effectiveness of containment measures.

Problema: La pandemia de Covid-19-CoV causada por el nuevo coronavirus (SAR-2)S se ha convertido en uno de los mayores desafíos de salud pública de este siglo. Método: Se trata de un estudio de relato de experiencia, realizado por estudiantes del último año de las carreras de medicina, enfermería y odontología de la Universidade do Estado do Amazonas (UEA), en el curso de internado rural en salud colectiva, en el municipio de Itapiranga, estado de Amazonas. Resultados: La experiencia que dio origen a la salud de los estudiantes no ocurrió el 20/09/19, visitas a comunidades ribereñas, enfermería, consultas y consultas médicas y odontológicas. Se implementaron medidas de prevención del Covid-19 en el municipio con la orientación de profesionales para el manejo de la enfermedad. Uso de mascarillas, aislamiento social y cierre de comercios fueron algunas de las medidas adoptadas tras el primer caso confirmado del virus, ocurrido el 21 de abril de 2020. Se realizaron testeos masivos en la población para detectar síntomas sintomáticos. Además, se contrataron profesionales de la salud como médicos, enfermeros, psicólogos y técnicos de enfermería para fortalecer el equipo de salud. Conclusión: La pasantía de salud rural en el municipio de Itapiranga representa una oportunidad única de interacción entre los estudiantes y, como equipos de salud del municipio, la oportunidad de una visión más amplia de la funcionalidad de la atención primaria de salud, especialmente en un período de pandemia. La atención es igual de importante tanto para la atención de la enfermedad como para la alerta de medidas de contención.

COVID-19 patients and vaccination / Antecedentes de vacunación en pacientes con COVID-19

Introduction: Vaccines against COVID-19 are effective. However, a percentage of people with a complete vaccination scheme are at risk of contracting and becoming ill from COVID-19. These cases are known as "vaccinated cases of infection". Objective: To identify the clinical characteristics of patients with SARS-CoV-2 infection with a history of vaccination for COVID-19. Methods: Retrospective cohort study in 271 vaccinated and positive patients who attended medical units in Baja California Sur, with or without a complete scheme and registered in SINOLAVE. Clinical characteristics, management, sequelae and mortality were analyzed. Descriptive statistics and association measures were used. Authorized by the ethics and research committees. Results: Age 48.5 ± 12.1 years, 19.5% met the definition of infection in vaccinated, 93% with outpatient management, 3.7% mortality, the most frequent comorbidity: diabetes / hypertension. 92% of the cases vaccinated with Cansino had COVID, followed by Pfizer with 26%. There is a higher risk of hospitalization and mortality in patients with an incomplete scheme. Conclusions: The vaccines are effective, most of the cases were ambulatory. Patients vaccinated with Cansino showed a higher COVID infection, the reinforcement of this vaccine could reduce the disease in patients already vaccinated. Of the patients who died, the majority did not have a complete vaccination schedule.

Introducción: Las vacunas contra la COVID-19 son efectivas. Sin embargo, un porcentaje de personas con esquema completo de vacunación tiene riesgo de contagiarse y enfermar por COVID-19. Estos casos se conocen como "casos de infección en vacunados". Objetivo: Identificar las características clínicas de los pacientes con infección por SARS-COV-2 con antecedente de vacunación para COVID-19.Métodos: Estudio de cohorte retrospectivo con 271 vacunados y positivos que acudieron a las unidades médicas en Baja California Sur, con esquema completo o sin él y registrados en el SINOLAVE. Se analizaron características clínicas, manejo, secuelas y mortalidad. Se utilizó estadística descriptiva y medidas de asociación. El estudio fue autorizado por los comités de ética e investigación. Resultados: Edad: 48.5 ± 12.1 años; 19.5% cumplieron con la definición de infección en vacunados; 93% con manejo ambulatorio; mortalidad del 3.7%; la comorbilidad mas frecuente: diabetes/hipertensión. El 92% de los casos vacunados con Cansino presentaron COVID, seguido por los que recibieron Pfizer, con el 26%. Existe mayor riesgo de hospitalización y mortalidad en pacientes con esquema incompleto. Conclusiones: las vacunas son efectivas, la mayoría de los casos fueron ambulatorios. Los pacientes vacunados con Cansino mostraron mayor infección por SARS-CoV-2; el refuerzo de esta vacuna, podría disminuir la enfermedad en los pacientes ya vacunados. De los pacientes que murieron, la mayoría no tenía esquema completo de vacunación.

Recommendations of the Spanish Group on Crohn's Disease and Ulcerative Colitis on the importance, screening and vaccination in inflammatory bowel disease patients. / Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa sobre la importancia, el cribado y la vacunación en pacientes con enfermedad inflamatoria intestinal.

Patients with inflammatory bowel disease (IBD) may require different immunosuppressive treatments throughout their illness. It is essential to assess the immunization status of patients at diagnosis or, if this is not possible, at least before the beginning of immunosuppressive therapy and, subsequently, administering the appropriate vaccines. Therefore, the aim of this work is to establish clear and concise recommendations on vaccination in patients with IBD in the different settings of our clinical practice including vaccination in children, during pregnancy, breastfeeding or on trips. This consensus document emphasises the differences between inactivated and attenuated vaccines and the different degrees of immunosuppression and correlates them with the administration of both mandatory and optional vaccines recommended to our patients with IBD. Finally, as a summary, 17 recommendations are established based on the available scientific evidence and expert opinion. A multidisciplinary team with extensive experience in IBD and vaccination, made up of specialists in gastroenterology, paediatrics, nursing and pharmacy, has participated in the preparation of these recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis.

The vaccine against COVID-19 and institutional trust. / La vacuna frente a la COVID-19 y la confianza institucional.

Major public and private laboratories have entered into a race to find an effective COVID-19 vaccine. When that vaccine arrives, the governments will have to implement vaccination programs to achieve the necessary immunization levels to prevent the disease transmission. In this context, the ethical dilemma of compulsory vaccination vs. voluntary vaccination will be raised. Underlying this dilemma, lies the problem of the ethical models on which the political decisions of governments in matters of health are based. The article proposes and argues the need to base health policy decisions on an ethical «first person¼ model, based on responsibility, that allows us to move from a normative ethic to an ethic of responsible behavior. This change in the ethical model, together with certain proposals for political action, will help us to restore institutional trust so that the necessary levels of collective immunity against COVID-19 can be achieved through the voluntary vaccination of the citizens.

Prevention of joint injuries in outdoor sports under the influence of covid-19 / Prevenção de lesões nas articulações em esportes ao ar livre sob a influência da covid-19 / Prevención de lesiones articulares en deportes al aire libre bajo la influencia del covid-19

ABSTRACT Introduction With the normalization of the prevention and control of the covid-19 epidemic, the proportion of outdoor sports in sports has gradually increased, but the risks have increased, resulting in joint injuries. Objective Explore the prevention of joint injuries in outdoor sports under the influence of covid-19. Methods 88 men and 64 women with ankle injuries, 45 men and 33 women with knee injuries, for a total of 133 men and 97 women volunteers were investigated by questionnaire, which included joint injuries, causes of injuries, and treatment methods after joint injuries, and the data were analyzed. Results Currently, most joint injuries in outdoor sports belong to minor injuries, which can recover after some minor readjustments and will not cause much impact on the sportsmen. However, there are also some serious injuries. Conclusion The athletes themselves must be fully prepared, including the use of protective gear and equipment, psychological adjustment, and learning knowledge about sports protection. Coaches and volunteers should give scientifically based and sensible guidance according to the actual situation of the sportsmen to reduce the incidence of joint injuries as much as possible. Level of Evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Com a normalização da prevenção e controle da epidemia de covid-19, a proporção de esportes ao ar livre no esporte tem aumentado gradualmente, mas os riscos têm aumentado, resultando em lesões articulares. Objetivo Explorar a prevenção de lesões nas articulações em esportes ao ar livre sob a influência da covid-19. Métodos 88 homens e 64 mulheres com lesões no tornozelo, 45 homens e 33 mulheres com lesões no joelho, num total de 133 homens e 97 mulheres voluntárias foram investigados por questionário, que incluiu lesões nas articulações, causas de lesões e métodos de tratamento após lesões nas articulações, tendo os dados sido analisados. Resultados Atualmente, a maioria das lesões nas articulações em esportes ao ar livre pertencem a lesões menores, que podem recuperar-se após alguns pequenos reajustes, o que não causará muito impacto nos esportistas, porém há também algumas lesões graves. Conclusão Os próprios esportistas devem estar totalmente preparados, incluindo o uso de aparelhos e equipamentos de proteção, o ajuste psicológico e o aprendizado dos conhecimentos sobre proteção esportiva. Os treinadores e voluntários devem dar orientações cientificamente fundamentadas e sensatas de acordo com a situação real dos praticantes do esporte, a fim de reduzir ao máximo a incidência de lesões articulares. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Con la normalización de la prevención y el control de la epidemia del covid-19, la proporción de deportes al aire libre en el deporte ha aumentado gradualmente, pero los riesgos han aumentado, dando lugar a lesiones articulares. Objetivo Explorar la prevención de lesiones articulares en deportes al aire libre bajo la influencia del covid-19. Métodos 88 hombres y 64 mujeres con lesiones de tobillo, 45 hombres y 33 mujeres con lesiones de rodilla, un total de 133 hombres y 97 mujeres voluntarios fueron investigados mediante un cuestionario, que incluía las lesiones articulares, las causas de las lesiones y los métodos de tratamiento después de las lesiones articulares, y se analizaron los datos. Resultados En la actualidad, la mayoría de las lesiones articulares en los deportes al aire libre pertenecen a lesiones menores, que pueden recuperarse tras unos pequeños reajustes, que no causarán mucho impacto en los deportistas, sin embargo, también hay algunas lesiones graves. Conclusión Los propios deportistas deben estar totalmente preparados, incluyendo el uso de equipos de protección, la adaptación psicológica y el aprendizaje de los conocimientos sobre protección deportiva. Los entrenadores y los voluntarios deben dar orientaciones con base científica y sensatas, de acuerdo con la situación real de los deportistas, para reducir al máximo la incidencia de las lesiones articulares. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Aromatherapy on Psycho-Emotional Symptoms and Fatigue in Nursing Professionals in the COVID-19 Setting / Aromaterapia en los síntomas psicoemocionales y fatiga en profesionales de enfermería en el marco de la COVID-19 / Aromaterapia nos sintomas psicoemocionais e fadiga em profissionais de enfermagem no contexto da COVID-19

Abstract Objective: To compare the effectiveness of aromatherapy with lavender essential oil (EO) versus an EO synergy on psycho-emotional symptoms and fatigue of nursing professionals in the COVID-19 setting. Materials and Methods: This is a quasi-experimental pilot study conducted in 2020. The professionals were randomized in Group 1 - lavender, and in Group 2 - lavender and other EOs synergy. The instruments were validated in Brazil, namely the Self-Reporting Questionnaire (SRQ-20) and the Fatigue Pictogram, which were applied at three moments: before the intervention, after 21 days of intervention, and three weeks after the end of the intervention follow-up. The data were evaluated using Pearson's x2 test or Fisher's exact test (dichotomous variables) and Student's t-test or Mann-Whitney test (continuous variables). Results: A total of 18 professionals participated, and both groups presented improved SRQ-20 scores (p < 0.010), which was maintained in the follow-up for Group 1 compared to the pre-intervention moment (p = 0.033). There was a significant decrease in fatigue in professionals in both groups (p = 0.010), but no difference was observed in the improvement of the impact of fatigue on daily life. Conclusions: There was a reduction in psycho-emotional symptoms and fatigue in nursing professionals who used aromatherapy during the COVID-19 pandemic in both groups.

Resumen Objetivo: comparar la efectividad de la aromaterapia con aceite esencial (AE) de lavanda versus una sinergia de AE en síntomas psicoemocionales y fadiga de profesionales de enfermería en el marco de la pandemia ocasionada por la covid-19. Materiales y método: estudio piloto casi-experimental realizado en 2020. Se hizo randomización de los profesionales en Grupo 1 - lavanda y Grupo 2 - sinergia lavanda y otros AE. Instrumentos validados en Brasil, Self-Reporting Questionnaire (SRQ-20) y Pictograma de Fadiga, se aplicaron en tres momentos: antes de la intervención, luego de 21 días de intervención y tres semanas tras el término de la intervención follow-up. Se evaluaron los datos por la prueba x2 de Pearson o prueba exacta de Fisher (variables dicotómicas) y por la prueba t de Student o Mann-Whitney (variables continuas). Resultados: participaron 18 profesionales y ambos grupos mostraron mejores puntuaciones del SRQ-20 (p < 0,010), que se mantuvo en el follow-up para el Grupo 1, comparado al momento preintervención (p = 0,033). Hubo disminución significativa de la fadiga de los profesionales en los dos grupos (p = 0,010), pero no se observó diferencia en la mejoría del impacto de la fadiga en la vida diaria. Conclusiones: hubo reducción en los síntomas psicoemocionales y la fadiga de profesionales de enfermería que emplearon aromaterapia durante la pandemia de la covid-19 en ambos grupos.

Resumo Objetivo: comparar a efetividade da aromaterapia com óleo essencial (OE) de lavanda versus uma sinergia de OE em sintomas psicoemocionais e fadiga de profissionais de enfermagem no contexto da covid-19. Materiais e método: estudo-piloto quase-experimental realizado em 2020. Os profissionais foram randomizados em Grupo 1 - lavanda e Grupo 2 - sinergia lavanda e outros OE. Instrumentos validados no Brasil, Self-Reporting Questionnaire (SRQ-20) e Pictograma de Fadiga, foram aplicados em três momentos: antes da intervenção, após 21 dias de intervenção e três semanas após o fim da intervenção follow-up. Os dados foram avaliados pelo teste x2 de Pearson ou teste exato de Fisher (variáveis dicotômicas) e pelo teste t de Student ou Mann-Whitney (variáveis contínuas). Resultados: participaram 18 profissionais e ambos os grupos mostraram melhora nos escores do SRQ-20 (p < 0,010), que se manteve no follow-up para o Grupo 1, comparado ao momento pré-intervenção (p = 0,033). Houve diminuição significativa da fadiga dos profissionais nos dois grupos (p = 0,010), porém não se observou diferença na melhora do impacto da fadiga na vida diária. Conclusões: houve redução nos sintomas psicoemocionais e na fadiga de profissionais de enfermagem que utilizaram aromaterapia durante a pandemia da covid-19 em ambos os grupos.

Análisis de la seguridad, accesibilidad y medidas de prevención e higiene de las instalaciones deportivas de la Región de Murcia durante la COVID-19 (Analysis of safety, accessibility and prevention and hygiene measures of sports facilities of the Murcia

Sports facilities are necessary for the practice of physical activity and these must comply with the minimum accessibility and safety requirements established to guarantee quality standards, as well as compliance with prevention and hygiene measures during the pandemic caused by COVID-19. The aim of this study was to analyse the degree of compliance with regard to the criteria of safety, accessibility and prevention and hygiene measures of sports facilities and equipment during COVID-19 in the Region of Murcia. To this end, a total of 34 sports facilities, 59 complementary spaces and 43 sports equipment were analysed, using a quantitative, descriptive and cross-sectional methodology. A total of seven ad hoc observation sheets were designed, comprising a total of 410 items and based on the applicable regulations and legislation in force. The results show that flooring is the sub-area with the highest degree of compliance, in toilets and changing rooms (89%) and in sports halls and fitness centres (92.14%). Signage and information show the lowest percentage of compliance in the three areas analysed, sports halls and fitness centres (65%), toilets and changing rooms (37%) and grandstands (42%). The analysis highlights the need to review and remedy the non-compliances detected in order to guarantee the quality of the sports facilities. Alternate : Las instalaciones deportivas son espacios necesarios para la práctica de la actividad física y estas deben de cumplir con los requisitos mínimos de accesibilidad y seguridad establecidos para garantizar los estándares de calidad, así como el cumplimiento de las medidas de prevención e higiene durante la pandemia motivada por la COVID-19. El objetivo del presente estudio fue analizar el grado de cumplimiento respecto a los criterios de seguridad, accesibilidad y medidas de prevención e higiene de las instalaciones y equipamientos deportivos durante la COVID-19 en la Región de Murcia. Para ello, se analizaron un total de 34 instalaciones deportivas, 59 espacios complementarios y 43 equipamientos deportivos, empleando una metodología de carácter cuantitativo de corte descriptivo y transversal. Se diseñaron un total de siete hojas de observación ad hoc, compuestas por un total de 410 ítems y basadas en la normativa y legislación vigente aplicable. Los resultados ponen de manifiesto que el pavimento es la sub-área con mayor grado de cumplimiento, en servicios higiénico-sanitarios y vestuarios (89%) y en pabellones y centros fitness (92.14%). Mientras que la señalización e información muestran el porcentaje más bajo de cumplimiento en las tres áreas analizadas, pabellones y centros fitness (65%), servicios higiénicos y vestuarios (37%) y graderíos (42%). El análisis pone de manifiesto la necesidad de revisión y subsanación de los incumplimientos detectados, para garantizar la calidad de las instalaciones deportivas.Alternate :As instalações desportivas são espaços necessários à prática de atividade física e estas devem cumprir os requisitos mínimos de acessibilidade e segurança estabelecidos para garantir os padrões de qualidade, bem como o cumprimento das medidas de prevenção e higiene durante a pandemia provocada pelo COVID-19. O objetivo deste estudo foi analisar o grau de cumprimento dos critérios de segurança, acessibilidade e prevenção e higiene das instalações e equipamentos desportivos durante o COVID-19 na Região de Múrcia. Para tal, foram analisadas 34 instalações desportivas, 59 espaços complementares e 43 instalações desportivas, utilizando uma metodologia quantitativa descritiva e transversal. Foram elaboradas sete fichas de observação ad hoc, compostas por um total de 410 itens e baseadas na regulamentação e legislação vigentes. Os resultados mostram que o pavimento é a subárea com maior grau de conformidade, nos serviços higiênico-sanitários e vestiários (89%) e nos pavilhões e academias (92,14%). Enquanto a sinalização e as informações apresentam o menor percentual de conformidade n s três áreas analisadas, pavilhões e academias (65%), banheiros e vestiários (37%) e arquibancadas (42%). A análise destaca a necessidade de rever e corrigir as infrações detetadas, para garantir a qualidade das instalações desportivas.

Hypertension: The most common chronic health problem in Spain. A call to action.

Hypertension (HYP) is the first cause of death and disability worldwide. In Spain, one in 3 adults was hypertensive in 2010 (62% in those >65 years in 2017). Despite improvement in HYP management over time, only half of treated hypertensive patients are adequately controlled, which translates in 30,000 annual cardiovascular deaths attributable to HYP. Among modifiable determinants of lack of blood pressure (BP) control in Spain are: (a) the white-coat phenomenon (accounting for 20-50% of apparent lack of control) due to not using ambulatory BP monitoring (ABPM, use ≈20%) or self-measurement of home BP (HBPM, use ≈60%) for confirming HYP diagnosis; (b) insufficient patients adherence to BP-lowering lifestyles (e.g., only 40% of hypertensive patients have a sodium intake <2.4g/day, or follow a weight reduction advice), and (c) use of drug monotherapy (≈50% currently), usually insufficient to achieve an optimal control. It is necessary to implement strategies to monitor the evolution of the proportion of subjects with HYP with reasonable national update, to promote population's knowledge of their BP figures and of other cardiovascular risk factors, to improve the degree of HYP control and vascular risk in Spain.

Prevalencia y factores asociados a infección por SARS-CoV-2 en adultos mayores institucionalizados

The objective of this study was to determine the prevalence of infection and the factors associated with COVID-19 in a geriatric institution in Cali, Colombia. This is an observational, cross-sectional study in institutionalized older adults after a COVID-19 outbreak. In a population of 252 adults who were screened for SARS-CoV-2. The prevalence of COVID-19 infection and its relationship with sociodemographic characteristics, comorbidities, symptoms, and geriatric clinimetry were analyzed using bivariate and multivariate regression models with prevalence ratios. Of this population, 84 (33.3%) were infected. A higher prevalence was found in adults ≥80 years (PR = 1.69 95% CI 1.16-2.47), with malnutrition (MNA <17) (PR = 1.44 95% CI 1.01-2.04 ) and with a Barthel index <60 (PR = 1.57 95% CI 1.09-2.25). Those infected presented mostly with fever (PR = 2.08 95% CI 1.39-3.09) and cough (PR = 1.61 95% CI 1.10-2.34). In conclusion, the prevalence of COVID-19 infection in institutionalized older adults is related to advanced age, malnutrition, and functional dependence.Alternate :El objetivo de este estudio fue determinar la prevalencia de infección y los factores asociados con la COVID-19 en una institución geriátrica de Cali, Colombia. Se trata de un estudio observacional de corte transversal en adultos mayores institucionalizados durante un brote de COVID-19. En una población de 252 adultos a los cuales se les realizó tamización mediante pruebas para detección de SARS-CoV-2, se analizó la prevalencia de la infección por la COVID-19 y su relación con las características sociodemográficas, comorbilidades, síntomas y clinimetría geriátrica mediante modelos de regresión bivariados con razones de prevalencias. De esta población, 84 (33,3%) se infectaron. Se encontró mayor prevalencia de la enfermedad en adultos ≥80 años (RP= 1,69 IC 95% 1,16-2,47), con malnutrición (MNA<17) (RP= 1,44 IC 95% 1,01-2,04) y con un índice de Barthel <60 (RP= 1,57 IC 95% 1,09-2,25). Los infectados se presentaron en su mayoría con fiebre (RP= 2,08 IC 95% 1,39-3,09) y tos (RP= 1,61 IC 95% 1,10-2,34). En conclusión, la prevalencia de infección por COVID-19 en el adulto mayor institucionalizado se relaciona con edad avanzada, malnutrición y dependencia funcional.

Main changes in the "COVID-19 in paediatrics" clinical practice guideline.

We present a summary of the main modifications to the "COVID-19 in Paediatrics" clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers. We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.

Strategies for COVID-19 transmission control and mitigation in a psychiatric hospital in Mexico.

In the context of the emerging COVID-19 pandemic, one of the great challenges is to generate effective strategies for the control of nosocomial infections, specifically in psychiatric hospitals with populations considered at risk (older adults or individuals with comorbidities). This article describes the strategies for prevention, containment and treatment of infection transmission implemented during a COVID-19 outbreak that occurred in July 2020 in a psychiatric hospital of the State of Mexico. The population was comprised by women with prolonged hospital stay (mean = 24 years), mostly geriatric (mean = 64 years), with various psychiatric disorders and comorbidities. In total, 19 COVID-19-positive cases were diagnosed, out of which thirteen had mild symptoms and six were asymptomatic. There were no alterations in mental state, psychiatric symptoms or underlying diseases. Algorithms were developed for the management and treatment of suspected/confirmed COVID-19 cases. Finally, the generation of comprehensive strategies, quick and timely actions, as well as adequate management of human resources favoring interdisciplinary work, were deemed to have contributed to contain and mitigate the COVID-19 outbreak, which constitutes a precedent in the psychiatric field with institutionalized patients.

En el contexto de la emergente pandemia de COVID-19, uno de los grandes desafíos es generar estrategias eficaces de control de infecciones nosocomiales, específicamente en hospitales psiquiátricos con población considerada de riesgo (adultos mayores o con comorbilidades). En el presente artículo se describen las estrategias de prevención, contención y tratamiento de contagio, a partir de un brote de COVID-19 ocurrido en julio de 2020 en un hospital psiquiátrico del Estado de México. La población estuvo constituida por mujeres con estancia hospitalaria prolongada (media = 24 años), en su mayoría geriátricas (media = 64 años), con trastornos psiquiátricos diversos y comorbilidades. En total se diagnosticaron 19 casos positivos de COVID-19, de los cuales 13 cursaron con sintomatología leve y seis resultaron asintomáticos. No se presentaron alteraciones en el estado mental, en la sintomatología psiquiátrica ni en las enfermedades de base. Se realizaron algoritmos para el manejo y tratamiento de los casos sospechosos o confirmados de COVID-19. Finalmente, se consideró que la generación de estrategias integrales, acciones rápidas y oportunas, así como una adecuada gestión de recursos humanos favorecedora del trabajo interdisciplinario contribuyeron a contener y mitigar el brote de COVID-19, constituyéndose en un precedente en el ámbito psiquiátrico con pacientes institucionalizadas.

[Prevention of infections related to health care in primary care. Lessons from the pandemic]. / Prevención de infecciones relacionadas con la asistencia sanitaria en atención primaria. Lecciones de la pandemia.

The health system failed to guarantee the safety of both professionals and citizens who came to the centers at the beginning of the pandemic. The lack of materials and guidelines for the prevention of infections caused in Spain the worst catastrophe in the history of patient safety and occupational health in healthcare. It also happened in other countries but Spain had the highest rates of infected health workers in the world. It was a largely avoidable event. We review what measures have been taken to prevent infections in primary care centers, such as hand hygiene, masks and personal protection material or the maintenance of social distance, among others. We update the recommendations and raise the perspectives in a situation that requires flexibility and adaptability to maintain quality and safe care.

Building long-term family resilience through universal prevention: 10-year parent and child outcomes during the COVID-19 pandemic.

As the COVID-19 pandemic has been highly stressful for parents and children, it is clear that strategies that promote long-term family resilience are needed to protect families in future crises. One such strategy, the Family Foundations program, is focused on promoting supportive coparenting at the transition to parenthood. In a randomized trial, we tested the long-term intervention effects of Family Foundations on parent, child, and family well-being one to two months after the imposition of a national shelter-in-place public health intervention in 2020. We used regression models to test intervention impact on outcomes reported on by parents in a standard questionnaire format and a series of 8 days of daily reports. We also tested moderation of intervention impact by parent depression and coparenting relationship quality. Relative to control families, intervention families demonstrated significantly lower levels of individual and family problems (general parent hostility, harsh and aggressive parenting, coparenting conflict, sibling relationship conflict, and children's negative mood and behavior problems), and higher levels of positive family relationship quality (positive parenting, couple relationship quality, sibling relations, and family cohesion). For some outcomes, including coparenting conflict, harsh parenting, and child behavior problems, intervention effects were larger for more vulnerable families-that is, families with higher pre-pandemic levels of parent depression or lower levels of coparenting relationship quality. We conclude that targeted family prevention programming is able to promote healthy parent and child functioning during unforeseen future periods of acute stress. The long-term benefits of a universal approach to family support at the transition to parenthood indicate the need for greater investment in the dissemination of effective approaches.

Dado que la pandemia de COVID-19 ha sido muy estresante para padres e hijos, está claro que se necesitan estrategias que promuevan la resiliencia familiar a largo plazo para proteger a las familias en crisis futuras. Una de esas estrategias, el programa Family Foundations, se centra en promover la crianza compartida de apoyo en la transición a la paternidad. En un ensayo aleatorizado, probamos los efectos de la intervención a largo plazo de Family Foundations en el bienestar de los padres, el niño y la familia uno o dos meses después de la imposición de una intervención nacional de salud pública de refugio en el lugar en 2020. Usamos modelos de regresión para evaluar el impacto de la intervención en los resultados informados por los padres en un formato de cuestionario estándar y una serie de 8 días de informes diarios. También probamos la moderación del impacto de la intervención por la depresión de los padres y la calidad de la relación de coparentalidad. En relación con las familias de control, las familias de intervención demostraron niveles significativamente más bajos de problemas individuales y familiares (hostilidad general de los padres, crianza dura y agresiva, conflicto de crianza conjunta, conflicto de relaciones entre hermanos y problemas de comportamiento y estado de ánimo negativos de los niños) y niveles más altos de calidad de relación familiar positiva (crianza positiva, calidad de la relación de pareja, relaciones entre hermanos y cohesión familiar). Para algunos resultados, incluido el conflicto de crianza compartida, la crianza severa y los problemas de comportamiento infantil, los efectos de la intervención fueron mayores para las familias más vulnerables, es decir, familias con niveles más altos de depresión de los padres prepandémicos o niveles más bajos de calidad de la relación de crianza compartida. Concluimos que los programas de prevención familiar específicos pueden promover el funcionamiento saludable de padres e hijos durante períodos futuros imprevistos de estrés agudo. Los beneficios a largo plazo de un enfoque universal del apoyo familiar en la transición a la paternidad indican la necesidad de una mayor inversión en la difusión de enfoques eficaces.

Estimation of the number of preventable COVID-19 deaths in relation to the restrictive measures adopted in Europe.

INTRODUCTION: In December 2019, a new coronavirus emerged in Wuhan, China, which has become a global health problem. OBJECTIVES: To estimate how many daily COVID-19 deaths per 100,000 population could have been avoided if each one of five restrictive measures had been implemented at the time the first case was diagnosed, and to estimate a multiple linear regression model predictive of the number of deaths per 100,000 population. METHODS: A simple linear regression was performed between the days elapsed since the first COVID-19 diagnosed case, implementation of each one of the five restrictive measures carried out by the 39 European studied countries, the number of hospital beds per 1,000 population (independent variables) and the number of COVID-19 deaths per 100,000 population. RESULTS: For each day elapsed from the first COVID-19 reported case to the adoption of restrictive measures, between 0.611 (p = 0.004) and 1.863 (p = 0.000) patients died per 100,000 population, depending on the implemented measure. CONCLUSIONS: Restrictive measures and social distancing, as well as promptness of their implementation, are necessary for achieving a decrease in COVID-19 infections and mortality.

INTRODUCCIÓN: En diciembre de 2019 surgió un nuevo coronavirus en Wuhan, China, que se ha convertido en un problema de salud global. OBJETIVO: Estimar cuántos fallecimientos diarios atribuibles a COVID-19 por cada 100 000 habitantes se podrían haber evitado si se hubiese llevado a cabo cada una de las cinco medidas restrictivas al momento del diagnóstico del primer caso, así como estimar un modelo de regresión lineal múltiple predictivo del número de fallecimientos por cada 100 000 habitantes. MÉTODOS: Se realizó un modelo de regresión lineal simple entre los días transcurridos desde el primer caso diagnosticado de COVID-19, la implantación de cada una de las cinco medidas llevadas a cabo por los 39 países europeos estudiados, el número de camas hospitalarias por 1000 habitantes (variables independientes) y el número de fallecimientos por COVID-19 por 100 000 habitantes. RESULTADOS: Por cada día transcurrido desde el primer caso notificado de COVID-19 hasta la adopción de las medidas restrictivas, fallecieron entre 0.611 (p = 0.004) y 1.863 (p = 0.000) pacientes por cada 100 000 habitantes, dependiendo de la medida implementada. CONCLUSIONES: Las medidas restrictivas y el distanciamiento social, así como la celeridad de su instauración, son necesarios para lograr el descenso del número de contagios de COVID-19 y su mortalidad.

Impact of COVID-19 prevention measures on health service quality, perceived value and user satisfaction. A structural equation modelling (SEM) approach.

OBJECTIVE: To explain using a structural equation model to patient satisfaction by analysing confidence in preventive measures against COVID-19 as an antecedent of this satisfaction and the effect that these measures have on the antecedents of service quality and perceived value. DESIGN: An observational cross-sectional study. SITE: Online survey was sent via social networks for recruiting citizens resident in Spain. PARTICIPANTS: The final sample consisted of 149 women and 122 men. The mean age of the participants was 36.73 years, all of whom were health service users. INTERVENTIONS: No interventions were conducted in the study. MAIN MEASUREMENTS: The study variables for the development of the structural equation model were: confidence in COVID-19 safety protocol, perceived value, quality and user satisfaction. RESULTS: The results showed a direct and positive effect of confidence in COVID-19 safety protocol on the quality of services provided, perceived value and user satisfaction. CONCLUSIONS: The study is expected to be of interest to those in charge of designing protective measures against the spread of diseases, health centre managers and marketing professionals interested in the improvement user satisfaction, affected as a result of the current pandemic.

The vaccine against COVID-19 and institutional trust.

Major public and private laboratories have entered into a race to find an effective Covid-19 vaccine. When that vaccine arrives, the governments will have to implement vaccination programs to achieve the necessary immunization levels to prevent the disease transmission. In this context, the ethical dilemma of compulsory vaccination vs. voluntary vaccination will be raised. Underlying this dilemma, lies the problem of the ethical models on which the political decisions of governments in matters of health are based. The article proposes and argues the need to base health policy decisions on an ethical "first person" model, based on responsibility, that allows us to move from a normative ethic to an ethic of responsible behavior. This change in the ethical model, together with certain proposals for political action, will help us to restore institutional trust so that the necessary levels of collective immunity against Covid-19 can be achieved through the voluntary vaccination of the citizens.

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU.

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.