Calidad de las espirometrías en atención primaria de Tenerife / Quality of spirometry in primary care in Tenerife, Spain

FUNDAMENTO: la espirometría es una prueba no invasiva y objetiva que mide la limitación del flujo aéreo y su técnica requiere unas condiciones que garanticen su calidad para que los resultados tengan valor clínico. OBJETIVOS: el objetivo de este estudio ha sido evaluar la calidad de las espirometrías realizadas en los Centros de Atención Primaria del Área de Salud de Tenerife. MÉTODOS: se realizó un estudio epidemiológico descriptivo para valorar la aceptabilidad y reproducibilidad de las espirometrías. RESULTADOS: el 45,7% de las espirometrías no se consideraron aceptables por el incumplimiento de alguno de los criterios de aceptabilidad. El error más habitual es la presencia de artefactos en la curva. De las espirometrías que reúnen todos los criterios de aceptabilidad, son reproducibles para FVC el 65,6%, para FEV1 el 91% y para FVC + FEV1 el 65,6%.CONCLUSIONES: existió un bajo número de espirometrías que cumplían los criterios de aceptabilidad y reproducibilidad, por lo que es necesaria la mejora de la calidad, con la presencia de personal fijo y bien formado que realice e intérprete estas pruebas de capacidad pulmonar

INTRODUCTION: spirometry is a non-invasive and objective assay that measures airflow limitation. This technique requires certain conditions in order to ensure its quality, so that results are of clinical value. The aim of the study was to analyze the quality of spirometry in primary health care centers in Tenerife, Spain. METHODS: a descriptive epidemiological study was designed in order to assess the reproducibility and acceptability of spirometries. RESULTS: 45,7 % of spirometries were considered non acceptable by unfulfilment of any of the acceptability criteria. Spirometries that met all the acceptability criteria were reproducible for FVC in 65,5% of cases, 91% for FEV1 and 65,6% for FVC and EV1. CONCLUSIONS: there is a low number of spirometries that meet acceptability and reproducibility criteria, thus it is make necessary to improve the quality of this test by the presence of fixed and trained personnel capable of performing and analyzing lung capacity tests

Análisis de series temporales aplicado a intoxicaciones atendidas en urgencias hospitalarias / Time series analysis of poisonings treated in a hospital emergency department

Objetivo: Establecer un sistema de control de calidad estadística para la tasa de incidencia acumulada semanal de intoxicaciones atendidas en un servicio de urgencias hospitalario. Métodos: Se empleó las notificaciones diarias de casos atendidos por intoxicaciones en el servicio de urgencias del Hospital Nuestra Señora de la Candelaria, entre enero de2005 y diciembre de 2009 para conformar la serie temporal de tasas las semanales de incidencia acumulada. Mediante metodología ARIMA (modelos autorregresivos integrados de medias móviles) se predijo el valor endémico esperado de esta tasa con un periodo de antelación suficiente como para tomar medidas de intervención oportunas apartir del comportamiento observado en este indicador. Resultados: Se recopiló una muestra de 3.550 notificaciones de intoxicaciones atendidas. Las tasas de incidencia acumulada anual en el periodo estudiado fluctuaron entre 128 por 100.000 habitantes del área de influencia del hospital en 2005 y 203 x por 100.000 en 2009, con un incremento semanal del 0,6%. El modelo ARIMA ajustado a la subserie 2005-2008 produjo un pronóstico de comportamiento de la tasa de intoxicaciones para 2009 que contrastado con lo observado en ese año nos permitió considerarlo adecuado. Conclusiones: El contraste del canal de control de calidad estadística de las intoxicaciones atendidas en urgencias con esta técnica para 2009 con el comportamiento observado en ese indicador durante ese mismo año permite considerar a este instrumento como adecuado y fiable para monitorizar el proceso asistencial de atención a las intoxicaciones en el servicio de urgencias hospitalario con vistas a una intervención oportuna sobre su incidencia (AU)

Objective: To establish a system of quality control for calculating the weekly cumulative incidence rates of poisoning streated in a hospital emergency department. Material and methods: Daily reports of poisoning cases treated in the emergency department of Hospital NS Candelaria from January 2005 to December 2009 were used to provide the time series for analysis of weekly cumulative incidencerates. An autoregressive integrated moving average (ARIMA) model was used to predict the expected endemic rate, to provide sufficient warning to allow for preparation of appropriate interventions based on that indicator’s behavior. Results: A total of 3550 reports of poisoning were collected. The annual cumulative incidences for the period studied ranged from 128 x 105 residents of the hospital’s catchment area in 2005 to 203 x 105 in 2009 (weekly increase of0.6%). The ARIMA model fitted to the 2005-2008 subseries predicted the behavior of 2009 incidence rates, which adequately reflected observations for that year.Conclusions: A comparison between the actual flow of poisoning cases in 2009 and the behavior of incidence rates predicted by the statistical model for that period suggests that this technique is a reliable and appropriate tool formonitoring the process of care in poisoning cases attended by a hospital emergency department wishing to bring intervention planning into line with expected incidence (AU)

[Assessment of the nutritional value of the menus served in school canteens on the island of Tenerife, Spain]. / Valoración nutricional de los menús escolares de los colegios públicos de la isla de Tenerife.

OBJECTIVE: To study the nutritional characteristics of the menus provided in the state primary schools of Tenerife and to assess whether they are adequate for the different age groups of school children. SCOPE AND METHODS: The study is conducted in 52 school canteens, with a population of 8,411 diners aged between 4 and 12 years old. 27 of the 52 school dinner services were managed directly and 25 were contracted out to catering companies. They were selected through a random sampling that was stratified by the different geographic areas of the island. A full menu was taken from each of them: first course, second course and dessert (in some cases, a dairy product, normally a piece of fruit). The food was recorded by weight. For assessing the nutritional input in the directly managed dining rooms, we took information on the menu, how it was prepared, the ingredients used and the proportion of each of these in each dish, the amount of oil and salt added, etc. Hence we calculate the proportion of each ingredient. We then weigh the different rations offered to the school children. In the case of the menus offered by catering companies, the quantity of the ration is weighed in the school dining room and, as the catering company supplies us with the breakdown of all the ingredients used in the dishes, we can determine the composition of the menus. To convert the food into nutrients, we used the Dietsource V 1.0 programme. The school menu is broken down using the diet, dish and food management plan, to give the proportions of active ingredients used, and the Recommended Inputs for the Spanish population are used as a reference for evaluating the nutritional quality of the diet, taking the average of the recommended value for the different age groups for each of the parameters. RESULTS: The carbohydrates account for 54% of the total energy, lipids 27% and proteins 19%. The mean content and standard error for cholesterol is 77.53 +/- 64.30 mg, so the mean cholesterol input per 1,000 kcal is 109 mg/1,000 kcal. Saturated fatty acids contribute 8.6% of the calorie input, monounsaturated fatty acids 11.7% and polyunsaturated fatty acids 9.7%. The fibre input per 1,000 kcal is 11 g. CONCLUSIONS: The energy value of the school menu is adequate, the percentage content of proteins is slightly high and the lipid and carbohydrate contents are within the limits. The percentage content of fatty acids is adequate, as are the percentage contents of cholesterol and fibre. The vitamin and mineral contents are appropriate, with the exception of iodine, zinc, iron and vitamins D, E and riboflavin, where there is a deficit, especially for the older children.

Valoración nutricional de los menús escolares de los colegios públicos de la isla de Tenerife / Assessment of the nutritional value of the menus served in school canteens on the island of Tenerife, Spain

Objetivo: Conocer las características nutricionales de los menús ofertados en los colegios públicos de Tenerife y valorar si son adecuados para los escolares, según los distintos grupos de edad. Ámbito y métodos: El estudio se realiza en 52 comedores escolares, con una población de 8.411 comensales, con edades comprendidos entre 4 y 12 años. Del total de colegios 27 eran de gestión directa y 25 de gestión contratada, seleccionados mediante un muestreo aleatorio estratificado según las distintas zonas geográficas de la isla. En cada uno de ellos se recogió un menú completo: primer plato, segundo plato y postre (en algunas ocasiones un lácteo, normalmente una pieza de fruta). El registro de alimentos se realizó por pesada. Para la valoración de la ingesta en los centros de gestión directa, recogimos información acerca del menú, la forma de preparación, los ingredientes utilizados y la proporción de los mismos en cada plato, la cantidad de aceite y sal añadidos, etc. Se calcula así la proporción de los distintos ingredientes. Posteriormente se procede a la pesada de las distintas raciones ofrecidas a los escolares. En el caso de los menús ofertados por catering se pesa la cantidad de la ración en el comedor escolar y al aportarnos, el propio catering el desglose de todos los ingredientes de los platos podemos conocer la composición de los menú. Para la conversión de los alimentos en nutrientes hemos utilizado el programa Dietsource V 1.0. Con la gestión de dietas, platos y alimentos se desglosa el menú escolar dando las proporciones en principios activos y utilizando como referencia las Ingestas Recomendadas para la población española se evalúa la calidad nutricional de la dieta, tomando en cada uno de los parámetros, la media del valor recomendado para los distintos grupos de edad. Resultados: Los hidratos de carbono representan un 54% de la energía total, los lípidos un 27% y las proteínas un 19%. El contenido medio y desviación estándar del colesterol es de 77,53 ± 64,30 mg, por lo que el aporte medio de colesterol por 1.000 kcal es de 109 mg/1.000 kcal. Los ácidos grasos saturados contribuyen en un 8,6% a la ingesta calórica, los ácidos grasos monoinsaturados con un 11,7% y los poliinsaturados con un 9,7%. La ingesta de fibra por 1.000 kcal se sitúa en 11 g. Conclusiones: El aporte de energía del menú escolar es adecuado, el contenido porcentual de proteínas es algo elevado y de lípidos y carbohidratos están dentro de los límites. El contenido porcentual de ácidos grasos es adecuado, así como el colesterol y fibra. El aporte de vitaminas y minerales es apropiado, con excepción del yodo, zinc y hierro, vitaminas D, E y riboflavina que son deficitarios, sobre todo para los niños de mayor edad (AU)

Objective: To study the nutritional characteristics of the menus provided in the state primary schools of Tenerife and to assess whether they are adequate for the different age groups of school children. Scope and methods: The study is conducted in 52 school canteens, with a population of 8,411 diners aged between 4 and 12 years old. 27 of the 52 school dinner services were managed directly and 25 were contracted out to catering companies. They were selected through a random sampling that was stratified by the different geographic areas of the island. A full menu was taken from each of them: first course, second course and dessert (in some cases, a dairy product, normally a piece of fruit). The food was recorded by weight. For assessing the nutritional input in the directly managed dining rooms, we took information on the menu, how it was prepared, the ingredients used and the proportion of each of these in each dish, the amount of oil and salt added, etc. Hence we calculate the proportion of each ingredient. We then weigh the different rations offered to the school children. In the case of the menus offered by catering companies, the quantity of the ration is weighed in the school dining room and, as the catering company supplies us with the breakdown of all the ingredients used in the dishes, we can determine the composition of the menus. To convert the food into nutrients, we used the Dietsource V 1.0 programme. The school menu is broken down using the diet, dish and food management plan, to give the proportions of active ingredients used, and the Recommended Inputs for the Spanish population are used as a reference forevaluating the nutritional quality of the diet, taking the average of the recommended value for the different age groups for each of the parameters. Result: The carbohydrates account for 54% of the total energy, lipids 27% and proteins 19%. The mean content and standard error for cholesterol is 77.53 ± 64.30 mg, so the mean cholesterol input per 1,000 kcal is 109 mg/1,000 kcal. Saturated fatty acids contribute 8.6% of the calorie input, monounsaturated fatty acids 11.7% and polyunsaturated fatty acids 9.7%. The fibre input per 1,000 kcal is 11 g. Conclusion: The energy value of the school menu is adequate, the percentage content of proteins is slightly high and the lipid and carbohydrate contents are within the limits. The percentage content of fatty acids is adequate, as are the percentage contents of cholesterol and fibre. The vitamin and mineral contents are appropriate, with the exception of iodine, zinc, iron and vitamins D, E and riboflavin, where there is a deficit, especially for the older children (AU)