Escabiosis en España: tendencias del interés público y consumo de ectoparasiticidas / Scabies in Spain: Trends in Public Interest and Ectoparasiticide Use

La escabiosis es una dermatosis ectoparasitaria causada por Sarcoptes scabiei var. hominis y cuyo reservorio son los humanos. En los últimos años se ha visto un incremento de los casos de escabiosis en nuestro país. El objetivo de este trabajo es complementar la evidencia existente sobre el aumento de la escabiosis en España mediante el estudio de la evolución del consumo de medicamentos ectoparasiticidas y el análisis temporal en Google Trends de las búsquedas en internet relacionadas con la infestación, así como explorar la relación entre ambos fenómenos. Nuestro estudio demuestra un incremento del interés público en la escabiosis y del consumo de ectoparasiticidas en los últimos años en España, existiendo una correlación positiva y significativa entre ambos fenómenos. Proponemos Google Trends como una herramienta complementaria a tener en cuenta a la hora de monitorizar en tiempo real el comportamiento de esta infestación en nuestro país (AU)

Scabies is an ectoparasitic dermatosis caused by the Sarcoptes scabiei var. hominis mite, which lives and reproduces in humans. Its incidence in Spain has increased in recent years. The aim of this study was to complement existing evidence on the increasing number of scabies cases in our country by analyzing changes in ectoparasiticide prescriptions and Internet searches for scabies infestations measured by Google Trends. We also examined correlations between these two variables. Our results show that public interest in scabies has increased in recent years and is positively and significantly correlated with an increasing use of ectoparasiticides. We believe that Google Trends should be considered as a complementary tool for monitoring real-time trends in scabies infestations in Spain (AU)

[Translated article] Scabies in Spain: Trends in Public Interest and Ectoparasiticide Use / Escabiosis en España: tendencias del interés público y consumo de ectoparasiticidas

Scabies is an ectoparasitic dermatosis caused by the Sarcoptes scabiei var. hominis mite, which lives and reproduces in humans. Its incidence in Spain has increased in recent years. The aim of this study was to complement existing evidence on the increasing number of scabies cases in our country by analyzing changes in ectoparasiticide prescriptions and Internet searches for scabies infestations measured by Google Trends. We also examined correlations between these two variables. Our results show that public interest in scabies has increased in recent years and is positively and significantly correlated with an increasing use of ectoparasiticides. We believe that Google Trends should be considered as a complementary tool for monitoring real-time trends in scabies infestations in Spain (AU)

La escabiosis es una dermatosis ectoparasitaria causada por Sarcoptes scabiei var. hominis y cuyo reservorio son los humanos. En los últimos años se ha visto un incremento de los casos de escabiosis en nuestro país. El objetivo de este trabajo es complementar la evidencia existente sobre el aumento de la escabiosis en España mediante el estudio de la evolución del consumo de medicamentos ectoparasiticidas y el análisis temporal en Google Trends de las búsquedas en internet relacionadas con la infestación, así como explorar la relación entre ambos fenómenos. Nuestro estudio demuestra un incremento del interés público en la escabiosis y del consumo de ectoparasiticidas en los últimos años en España, existiendo una correlación positiva y significativa entre ambos fenómenos. Proponemos Google Trends como una herramienta complementaria a tener en cuenta a la hora de monitorizar en tiempo real el comportamiento de esta infestación en nuestro país (AU)

Scabies in Spain: Trends in Public Interest and Ectoparasiticide Use. / Escabiosis en España: tendencias del interés público y consumo de ectoparasiticidas.

Scabies is an ectoparasitic dermatosis caused by the Sarcoptes scabiei var. hominis mite, which lives and reproduces in humans. Its incidence in Spain has increased in recent years. The aim of this study was to complement existing evidence on the increasing number of scabies cases in our country by analyzing changes in ectoparasiticide prescriptions and Internet searches for scabies infestations measured by Google Trends. We also examined correlations between these two variables. Our results show that public interest in scabies has increased in recent years and is positively and significantly correlated with an increasing use of ectoparasiticides. We believe that Google Trends should be considered as a complementary tool for monitoring real-time trends in scabies infestations in Spain.

[Translated article] Scabies in Spain: Trends in Public Interest and Ectoparasiticide Use.

Scabies is an ectoparasitic dermatosis caused by the Sarcoptes scabiei var. hominis mite, which lives and reproduces in humans. Its incidence in Spain has increased in recent years. The aim of this study was to complement existing evidence on the increasing number of scabies cases in our country by analyzing changes in ectoparasiticide prescriptions and Internet searches for scabies infestations measured by Google Trends. We also examined correlations between these two variables. Our results show that public interest in scabies has increased in recent years and is positively and significantly correlated with an increasing use of ectoparasiticides. We believe that Google Trends should be considered as a complementary tool for monitoring real-time trends in scabies infestations in Spain.

Hospital surge capacity preparedness in disasters and emergencies: a systematic review.

BACKGROUND: Adequate and effective emergency preparedness for hospital surge capacity is a prerequisite to ensuring standard healthcare services for disaster victims. This study aimed to identify, review, and synthesize the preparedness activities for and the barriers to hospital surge capacity in disasters and emergencies. METHODS: We systematically searched seven databases (PubMed, MEDLINE, CINAHL, Scopus, Embase, Ovid, and PsycINFO). We included all English peer-reviewed studies published in January 2016 and July 2022 on surge capacity preparedness in hospital settings. Two independent researchers screened titles and abstracts, reviewed the full texts, and conducted data extractions using CADIMA software. We assessed the rigor of the included studies using the NIH quality assessment tools for quantitative studies, the Noyes et al. guidelines for qualitative studies, and the MMAT tool for mixed methods studies and summarized findings using the narrative synthesis method. We also used PRISMA reporting guidelines. RESULTS: From the 2560 studies identified, we finally include 13 peer-reviewed studies: 10 quantitative, one qualitative, and two mixed methods. Five studies were done in the USA, three in Iran (n = 3), and the remaining in Australia, Pakistan, Sweden, Taiwan, and Tanzania. The study identified various ways to increase hospital surge capacity preparedness in all four domains (staff, stuff, space, and system); among them, the use of the Hospital Medical Surge Preparedness Index and the Surge Simulation Tool for surge planning was noteworthy. Moreover, nine studies (69%) recognized several barriers to hospital surge capacity preparedness. CONCLUSION: The review provides synthesized evidence of contemporary literature on strategies for and barriers to hospital surge capacity preparedness. Despite the risk of selection bias due to the omission of gray literature, the study findings could help hospital authorities, public health workers, and policymakers to develop effective plans and programs for improving hospital surge capacity preparedness with actions, such as enhancing coordination, new or adapted flows of patients, disaster planning implementation, or the development of specific tools for surge capacity. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022360332.

Prevalence and severity of periodontal disease among Spanish military personnel.

INTRODUCTION: Periodontal disease ranges from simple gums inflammation to major damage to the periodontal tissues, even losing teeth. Severe periodontitis has a world overall prevalence of 11.2%. These are evaluated with periodontal probes and oral epidemiological indices. Our aim is to estimate the prevalence and severity of periodontal disease of a Spanish military population according to the 2013 WHO criteria. METHODS: Observational study of prevalence carried out in a representative random sample of 221 military staff from the Spanish Army base 'Conde de Gazola'. Prevalence was estimated by calculating the Community Periodontal Index modified, loss of attachment, Plaque Index and Gingival Bleeding Index measured with a third-generation electronic 'Pa-on' periodontal probe. RESULTS: Averages of probing depth, recession and clinical attachment level were 2.17, 0.19 and 2.36 mm. Plaque and gingival bleeding indices were 71% and 40.3%. All subjects bled in some tooth after probing. 3.6% of subjects had no periodontal pockets, 58.8% mild periodontal pockets and 37.1% severe periodontal pockets. All had some loss of attachment, 52% mild loss of attachment and 47.5% severe loss of attachment. Teeth present with and without bleeding were 24.4 (86.5%) and 3.6 (13.1%). 28% of teeth had periodontal pockets and 40.4% loss of attachment. Sextant averages with periodontal pockets and loss of attachment were 2.79 and 3.56. CONCLUSIONS: Our plaque and gingival bleeding indices were high and we found a higher prevalence and severity of periodontal disease than other Spanish and foreign military populations. This could be related to differences in context, life habits and insufficient dental hygiene.

Epidemiological methods used in the periodontal health research in military personnel: a systematic review.

INTRODUCTION: Periodontal disease is a prevalent pathology in military personnel worldwide. The objective is to analyse the methodological features of periodontal health research performed in military personnel in their home countries. METHODS: A PRISMA systematic review of literature was carried out in PubMed, EMBASE and Web of Science databases on military periodontal health studies. Study design type, language, publication date, year, country, size and sample selection, age, sex, military, diagnostic procedure, examiners, periodontal, gingival and oral hygiene index were extracted. RESULTS: Eighty-eight out of 5355 studies found were selected, published between 1921 and 2020, with samples ranging from 52 to 16 869 individuals, generally not randomised, and consisting mainly of men with a mean age of 25 years. Predominant studies were cross-sectional descriptive studies, carried out in the Army, on American military personnel, and in the English language. Most of the studies used the WHO periodontal probe handled by two or more examiners. The Löe and Silness gingival index and the Silness and Löe plaque index were the most used indexes to assess gingival condition and oral hygiene, respectively. Community Periodontal Index of Treatment Needs was the most widely used periodontal index. CONCLUSIONS: Research on periodontal health carried out in military populations from the 1920s to the present has been performed from an almost exclusively descriptive approach. Issues such as the characteristics and representativeness of the samples, the epidemiological design and the different gingival-periodontal indexes used may limit the comparability of the study results.

Aplicabilidad de los sistemas de triaje prehospitalarios en los incidentes de múltiples víctimas: de la teoría a la práctica / From theory to practice in the applicability of prehospital multiple-casualty incident triage systems: a systematic review

En los incidentes de múltiples víctimas (IMV), el triaje determina en gran medida los resultados finales en cuanto a asistencia sanitaria, organización y disminución de la morbimortalidad. La doctrina asistencial recomienda la realización del triaje ya en el ámbito prehospitalario para organizar la asistencia y evacuación de los heridos. Analizamos la aplicabilidad real de las recomendaciones en cuanto al triaje prehospitalario en IMV medianteuna revisión sistemática de la literatura científica utilizando como palabras clave "mass casualty triage" y "prehospital triaje". Se usan como fuentes de datos PubMed, Cochcran y las revistas EMERGENCIAS y Prehospital and Disaster Medicine. También se revisó la bibliografía de los artículos localizados. Se localizaron 561 artículos con los criterios de búsqueda, de los que 19 cumplían todos los criterios de inclusión. Es escasa la referencia que se hace a la metodología de triaje realizada, y en muchos de ellos se hace referencia explícita a la no realización del triaje. Existe una discrepancia entre la doctrina asistencial ante IMV y los datos publicados que puede ser debida a la dificultad de obtener datos en la escena del siniestro, a que las dificultades asistenciales no permiten aplicarla doctrina asistencial, o que ésta no es válida (AU)

Triage has a great effect on results in multiple-casualty incidents (MCIs), reducing morbidity and mortality through the allocation and organization of health care resources. Prehospital triage to organize care and evacuate casualties is a key theoretical premise in emergency health care. To analyze the applicability of prehospital triage recommendations for MCIs, we searched the literature using the search terms mass casualty triage and prehospital triage in the PubMed database, the Cochrane Library, and the journals Emergencias and Prehospital and Disaster Medicine. We also checked the reference lists of all articles found. Of a total of 561 titles located, 19 met the inclusion criteria. The articles offer little information on methods used for triage in MCIs and many explicitly state that no triage system was used. There is inconsistency between the theoretical approach to care applicable in MCIs and the reports of actual events, possibly because it is difficult to obtain data at the scene of the incident, because care giving interferes with the application of theory, or because the theory itself is invalid (AU)

Enfermedades de transmisión vectorial potencialmente emergentes en la cuenca mediterránea y su posible relación con el cambio climático / Potentially emergent vector-borne diseases in the Mediterranean and their possible relationship with climate change

El cambio climático influye sobre la frecuencia y distribución de las enfermedades de transmisión vectorial (ETV). El objetivo del trabajo es examinar la evidencia científica disponible sobre la modificación producida por el cambio climático en las ETV en Europa,especialmente en la vertiente europea la cuenca mediterránea, así como los mecanismos implicados en esos cambios. Para ello se revisa la literatura científica disponible hasta septiembre de 2010 sobre las alteraciones producidas por el cambio climático en las ETV en Europa, especialmente las que potencialmente pueden resultar más afectadas como el paludismo, el dengue, la fiebre Chikungunya, la fiebre del Valle del Rift, la fiebre del Nilo Occidental, la leishmaniosis, infecciones por Hantavirus, la fiebre botonosa mediterránea, la fiebre hemorrágica del Congo Crimea y la enfermedad de Lyme.Existe evidencia de que se está produciendo un aumento de casos autóctonos y de brotes epidémicos. Este aumento de casos de las ETV estudiadas en la cuenca mediterránea que puede estar asociado a la modificación de las variables climáticas de la temperatura ambiental y la humedad relativa, aunque el efecto es difícil de notificar y atribuir al cambio climático porque la frecuencia de los casos depende también de otros elementos como el comportamiento humano, el crecimiento económico, la adaptabilidad del sistema terrestre y la capacidad para detener los cambios (AU)

Climate change affects the frequency and distribution of diseases transmitted by vectors. Our aims were to review the literature on the effects of climate change and vector-borne diseases in Europe, particularly in the Mediterranean area, and to consider the mechanisms implicated in changes. The literature published by September 2010 on changes invector-borne diseases in Europe was reviewed. We emphasized disease that might potentially be affected by climate change, such as malaria, dengue fever, chikungunya fever, Rift Valley fever, West Nile fever, leishmaniasis, hantavirus infection, Mediterranean spotted fever, Crimean-Congo hemorrhagic fever, and Lyme disease. There is evidence of an increase in outbreaks and in locally acquired cases. The frequency of vector-borne diseases is increasing in the Mediterranean region, possibly associated with changes in temperature and relative humidity. The effect is difficult to perceive or attribute to climate change, however, because frequency also depends on factors such as human behavior, economic growth, the adaptability of the planet, and the prospects of stopping change (AU)

Indicadores de riesgo de morbilidad prevenible causada por medicamentos en pacientes atendidos en un servicio de urgencias hospitalario / Risk indicators of preventable morbidity caused by medication in patients attended at a hospital emergency service

Objetivos: Los objetivos principales de este trabajo son: estudiar la frecuencia de los 43 indicadores de riesgo de morbilidad prevenible causada por medicamentos (RMPM), identificados previamente, en pacientes con tratamiento farmacológico que acuden a un servicio de urgencias hospitalario; describir las características de los pacientes en los que estaba presente el indicador, y establecer si el motivo de consulta y la gravedad de los pacientes coinciden con alguna de las situaciones clínicas descritas en los indicadores. Método: Estudio observacional descriptivo transversal que utiliza la base de datos de un estudio multicéntrico sobre prevalencia de resultados negativos de la medicación en el Hospital Universitario Central de Asturias. Criterios de inclusión de pacientes: a) estar tomando un medicamento relacionado con las situaciones clínicas descritas en los indicadores; b) presentar una enfermedad relacionada con los indicadores de resultados de problemas relacionados con medicamentos, y c) acudir a urgencias por un motivo relacionado con los indicadores. Resultados: Se estudiaron 436 pacientes. El perfil del paciente con indicador es una mujer mayor de 64 años que utiliza cuatro o más medicamentos. Cincuenta y siete pacientes (13,1%) presentaban alguna de las situaciones descritas en los indicadores. Un 28% tenía un indicador relacionado con AINE, un 26,3% con asma/EPOC, un 8,8% con osteoporosis y un 7% con uso de digoxina y medicamentos psicótropos. El 68,4% de los pacientes con indicador mostraban una gravedad leve, un 7% moderada y un 19,3% grave. Conclusiones: Se hallaron 17 indicadores (39,5%) en 57 pacientes (13%) de los que acudieron al servicio de urgencias. En más del 80% (46) de esos pacientes el motivo por el que acudieron a urgencias fue presentar alguna situación descrita en los indicadores. El 25% (14) de los pacientes con indicador presentaban una situación grave y tuvieron que ser ingresados. Los pacientes del grupo con indicador presente tenían más edad, ingresaban más y usaban más medicamentos de media (AU)

Objectives: The main objective of this study is to identify and determine the frequency of these 43 drugs related morbidity (PDRM) previously identifi ed in patients undergoing pharmacological treatment and who attended a hospital emergency department. Another objective is to describe the characteristics of the patients who present the indicator and establish whether the reason for attending the emergency department was related with the indicator (morbidity) and if the severity of the patients’ condition coincides with any of the clinical scenarios described in the indicators. Method: Cross-sectional, descriptive, observational study based on the database on the prevalence of drug-related negative clinical outcomes from a multicenter study conducted in the emergency department of the Hospital Universitario Central de Asturias (HUCA). Patients who complied with the following criteria were studied: a) use of a drug related to one of the clinical situations described in the indicators; b) present a disease associated with the result indicators of problems related with drugs; c) the reason for attending the emergency department is related to the indicators. Results: A total of 436 patients were studied. The profi le of a patient with a clinical condition matching an indicator is a woman aged 64 years old who uses 4 or more drugs. Fifty-seven patients (13.1%) presented one of the situations described in the indicators: 28% it was an indicator related with NSAIDs, 26.3% with asthma/COPD, in 8.8% with osteoporosis and 7% with the use of digoxin and psychotropic drugs. The 68.4% of the patients with an indicador showed mild severity, 7% moderate and 19.3% serious. Conclusions: 17 indicators (39.5%) were detected in 57 patients (13%) of those who attended the emergency department. In more than 80% of the patients (46) the reason for going to the emergency department was one of the situations described in the indicators. The condition of 25% of the patients (14) with an indicator showed a severe situation and had to be hospitalized. The patients of the group with a present indicator were older, where hospitalized more often and used more medications than the mean (AU)

Sistema sanitario y triaje ante una pandemia de gripe: un enfoque desde la salud pública / Triage in the health care system during an influenza pandemic: a public health perspective

La actual situación de pandemia gripal a la que se enfrenta nuestro sistema sanitario supone todo un reto que debe de ser gestionado de una manera integral por parte de los responsables sanitarios. Debido a una más que probable saturación del sistema sanitarioa todos los niveles, es necesario instaurar protocolos de triaje coordinados entrelos distintos niveles asistenciales. En este artículo se presenta como novedad el importante papel que puede tener el triaje como una herramienta al servicio de los profesionales sanitarios para gestionar los flujos de pacientes que se producirán debido a la pandemia gripal, sin entrar a analizar los distintos protocolos de triaje que ya se manejana nivel internacional. En definitiva, se da al triaje una importancia relevante en cuanto a su papel como herramienta clínica al servicio de la salud pública (AU)

The current influenza pandemic confronting our health care system is a challenge for the responsible authorities to manage with an integrated, system-wide approach. As the entire health care system is likely to become overburdened, referrals between different levels of care should be coordinated, guided by the use of triage protocols. This paper discusses the new and important role of triage as a tool for managing patient flow during an influenza pandemic, although the specifics of the various protocols already in use internationally are not analyzed in detail. Certainly, triage is a key clinical tool at the service of public health (AU)

[A system, developed by prescribing doctors, of indicators of the quality of pharmaceutical prescription in primary care]. / Un sistema de indicadores de calidad de prescripción farmacéutica en atención primaria desarrollado por médicos prescriptores.

OBJECTIVE: To work out a system of indicators and standards, designed by means of a consensus group of general practitioners, that enables evaluation of the quality of Primary Care prescription to be improved. Design. Informal consensus method. SETTING: A PC area in Asturias with 156 614 inhabitants and 9 health centres.Participants. Nine PC doctors accepted voluntarily to take part in the project. METHOD: A consensus group of nine PC doctors was formed. At a first meeting they worked out some potential indicators of quality of prescription. After applying these indicators to the prescription data, a second meeting was held, at which the results of applying the indicators along with criteria of excellence were used to establish the definitive indicators and their numerical values of optimum compliance. RESULTS: It was possible to agree by consensus 11 indicators of quality of prescription and their values of optimum compliance. Eight of the indicators referred to choice of a medicine within a pharmaco-therapeutic group; and three, to groups in which the volume of prescription may suggest improper usage. CONCLUSIONS: It is feasible for PC doctors to reach a consensus on a group of criteria that is perceived as valid for measuring quality of prescription and which includes certain impalpable values for determining quality.

Un sistema de indicadores de calidad de prescripción farmacéutica en atención primaria desarrollado por médicos prescriptores / A system, developed by prescribing doctors, of indicators of the quality of pharmaceutical prescription in primary care

Objetivo. Elaborar un sistema de indicadores y estándares, diseñado mediante un grupo de consenso de médicos generales, que permita mejorar la evaluación de la calidad de la prescripción en atención primaria (AP).Diseño. Método de consenso informal. Emplazamiento. Un área de AP de Asturias con 156.614 habitantes y 9 centros de salud. Participantes. Aceptaron participar voluntariamente en el estudio 9 médicos de AP. Método. Se formó un grupo de consenso de nueve médicos de AP que en una primera reunión elaboró unos posibles indicadores de calidad de prescripción. Tras aplicar estos indicadores a los datos de prescripción, se celebró una segunda reunión donde, a partir de los resultados de la aplicación de los indicadores y basándose en criterios de excelencia, se establecieron los indicadores definitivos y sus valores numéricos de cumplimiento óptimo. Resultados. Fue posible consensuar 11 indicadores de calidad de prescripción y sus correspondientes valores de cumplimiento óptimo. De los indicadores, ocho se refieren a la selección de un fármaco dentro de un grupo farmacoterapéutico, y tres a grupos donde el volumen de prescripción puede indicar una utilización inadecuada. Conclusiones. Es factible alcanzar un consenso entre los médicos de AP acerca de un conjunto de criterios, que sea percibido como válido para medir la calidad de prescripción y que incorpore determinados valores intangibles que la determinan (AU)

Epidemiología de la demanda asistencial urgente por insuficiencia cardíaca congestiva / Epidemiology of the demand for acute health care due to congestive heart failure

Objetivo: Estudio de la demanda urgente y su proceso asistencial por insuficiencia cardiaca congestiva (ICC) en un hospital de área de salud de nivel II. Método: Diseño epidemiológico observacional de corte transversal sobre 242 pacientes mayores de 14 años con criterios de ICC, que demandaron asistencia por urgencias del 1 de junio al 20 de septiembre de 2000.Resultados: La edad media fue de 77,9 años ( =11,2). Había 113 (46,5 por ciento) hombres y 129 (53,1 por ciento) mujeres y sus edades medias (75,6 y 80 años, respectivamente) diferían significativamente (p<0,05).Demandan asistencia urgente un promedio de dos veces al año y uno de cada dos termina siendo ingresado. Los episodios se repiten en promedio cada 75 días. Sólo uno de cada tres fueron atendidos antes por su médico de atención primaria y sólo el 5 por ciento reingresan antes de las 72 horas tras el alta. Los principales factores de riesgo son la hipertensión, cardiopatía isquémica, diabetes, EPOC y obesidad (más diabetes en mujeres y más EPOC en hombres).El esquema terapéutico de la ICC sigue basándose en el diurético de asa, el inhibidor de la enzima conversiva de angiotensina y la digoxina. La práctica clínica analizada muestra poco uso de espironolactona (valvulopatía), IECAs (hipertensión y miocardiopatía) y Beta-bloqueantes (hipertensión). Conclusiones: El paciente tipo es un hombre o mujer de edad avanzada que acude a urgencias por iniciativa propia, siendo su primer ingreso. Sólo la mitad saben que tienen ICC. El varón presenta un mayor deterioro clínico en relación a su disfunción sistólica a diferencia de la mujer en la que descompensación se debe a una arritmia cardiaca por fibrilación auricular con función sistólica conservada. El esquema terapeútico sigue siendo el clásico (AU)

[Pharmaceutical care in people who have had acute coronary episodes (TOMCOR study)]. / Atención farmacéutica en personas que han sufrido episodios coronarios agudos (Estudio TOMCOR).

BACKGROUND: This study evaluates the effects on coronary patients of a new practice in community pharmacies called Pharmaceutical Care (PhC) as compared to the traditional pattern of pharmacy practice. It attempts to ascertain whether pharmaceutical care is feasible in addition to ascertaining differences in effectiveness for coronary patients' pharmacotherapeutic health outcomes, potentially attributable to PhC. METHODS: A randomized prospective controlled-intervention study was conducted in 83 community pharmacies in the provinces of Asturias, Barcelona, Madrid and Biscay in a one-year monitoring of the drug-use of 735 patients at the start of the study (330 intervention patients and 405 control) and 600 at the end. RESULTS: Differences were fund in favor of the intervention group in: a) the use of health care services as a morbidity indicator such as frequency of hospital emergency room visits 1.27 I (CI95%; 1.10-1.44) and 1.63 C (CI95%; 1.36-1.90) or average length-of-stay in Intensive Care Units 2.46 I (CI95%; 1.56-3.36) and 5.87 C (CI95%; 3.57-8.17), both due to coronary causes; b) health-related quality of life score (physical functioning dimension difference of 4.7 (p < 0.05); c) average patient knowledge of coronary heart disease risk factors having improved by 10% (p < 0002-0.007 depending on dimension); d) patient knowledge of the name and identification of their drugs having improved by 10% (p < 0.001) along with their subjective perception of the antiagregans drugs relative importance having improved by 12% (p < 0.009) and effects of beta-blockers having improved by 25% (p < 0.02); e) average satisfaction with pharmaceutical care service and perception of pharmacist's professional competence having improved by 2% (p < 0.000 to 0.05 depending on dimension). CONCLUSIONS: A decrease in emergency health care demand due to coronary causes, a fewer number of patient hospitalizations and a shorter length-of-stay in Coronary Intensive Care Units due to hospitalization regarding coronary patients on pharmaceutical care would suggest that patients who suffered an acute coronary heart episode made a better use of drugs and would tend to be less ill. Furthermore, coronary patients who received pharmaceutical care services showed a better knowledge of the reasons for their pharmacotherapy and therefore took better advantage of health care resources and improved their health condition.

[Risk of chemical disaster as a public health problem]. / El riesgo de desastre químico como cuestión de salud pública.

This revision is aimed at providing health care personnel, particularly those who may be involved in planning and/or responding to a chemical accident, with an overview of the subject of major industrial accidents. In the introduction, a brief presentation is made of some data concerning the main industrial disasters which have occurred in the past in addition to some accidents which have occurred in our area that could have evolved into a major accident. A review is also provided of Spanish and European laws currently in effect regarding this matter, in addition to summarizing the main consequences which may result from explosions, phenomena of a thermal type and the leakage of hazardous substances, particularly stressing the third of these three cases. A brief summary is also given of the main steps to be taken for a correct risk analysis in a given geographical area. Lastly, the overall organization of the Chemical Industry Emergency Plans and the functions of the different groups taking part therein, including the main functions of the medical team, is provided. Planning and responding to an industrial disaster is markedly multi-disciplinary endeavor, and this document is aimed at providing health care professionals with an overview of the main aspects involved in order to thus contribute to a more in-depth knowledge of a subject which we consider to be of importance for health care personnel and a better-integrated response, given that were an industrial disaster to occur, we would have to deal with a serious public health care problem on the spot.

[The evaluation of hospital management of sanitary waste in the principality of Asturias]. / Evaluación de la gestión hospitalaria de residuos sanitarios en el Principado de Asturias.

BACKGROUND: With the object of evaluating the management of sanitary waste of 12 publicly funded Asturian hospitals, a visit was paid to the hospital services, particularly significant as regards the generation of waste (a total of 91 services). The evaluated hospitals represent 75.10% of the total hospital beds in the Principality. METHODS: Interviews with personnel from 91 different services were undertaken, always by the same interviewer, and according to the rules of the Joint Commission of Health Care Organizations. The information obtained was afterwards verified by the interviewer by means of direct observation. RESULTS: Amongst the most relevant results, the absence of adequate containers for "clinical" waste in 28.5% of the services visited, stands out. Into the bargain, 82.4% of the services classify this type of waste incorrectly. The percentage of incorrect classification is 1.1% for "special" waste. In large hospitals (with over 300 beds), 60% of the services have information on the handling of waste, but only 40% of these hospitals have adequate supervision over the management of waste by the Service of Preventive Medicine or another equivalent service. CONCLUSIONS: The level of incorrect classification of sanitary waste which has been discovered suggests that, in order to improve the intra-hospital management of waste, it is necessary to increase the amount of information, modify certain attitudes of the hospital staff and reinforce the level of supervision executed by the Services of Preventive Medicine.