Importancia de la formación continuada de los profesionales en la prevención de caídas en pacientes geriátricos institucionalizados / Importance of the continuing education of professionals in the prevention of falls among institutionalized geriatric patients

Introducción: La caída es el tipo de accidente más frecuente y según la evidencia científica entre un 50 y 60% de los ancianos institucionalizados en residencias caen una vez al año. Las complicaciones son la principal causa de muerte por accidente y la sexta causa de muerte en personas mayores de 65 años. Prevenir este tipo de accidentes es uno de los objetivos prioritarios en todos los ámbitos de atención a los ancianos y muy especialmente en los centros residenciales y unidades de larga estancia. Los profesionales que se encuentran en la atención directa tienen la necesidad de determinar las causas del problema y valorar la eficacia de las múltiples acciones de prevención que llevan a cabo de forma interdisciplinaria. Fruto de esta colaboración se realizan diferentes trabajos donde se dan a conocer los resultados obtenidos. Objetivo: A fin de demostrar el interés en el tema entre los profesionales, y analizar las acciones de prevención que resultan más eficaces, nos planteamos realizar una revisión sistemática de los estudios científicos publicados durante los últimos 15 años, en el ámbito mundial y sin límites de idioma, acerca de las diferentes intervenciones de prevención de caídas en pacientes geriátricos institucionalizados en residencias y unidades de larga estancia. Material y Método: La población de estudio está compuesta por ensayos clínicos controlados y asignados aleatoriamente acerca de intervenciones de prevención primaria de caídas, en pacientes geriátricos institucionalizados en residencias y unidades de larga estancia, publicados en últimos 15 años en el ámbito mundial y sin límite de idioma. Para la búsqueda bibliográfica se combinaron 24 bases de datos científicos, consulta de catálogos de bibliotecas, utilización de buscadores especializados en Internet y consulta con expertos. El equipo investigador revisó un total de 2.382 estudios de los cuales se analizaron 156; finalmente se seleccionaron 7 estudios de forma enmascarada, previo examen de su calidad metodológica mediante el Checklist of Consort Statement (2002). Se ha realizado un análisis descriptivo para obtener información de tema y posteriormente un metaanálisis para determinar la eficacia de las intervenciones de prevención de caídas. Resultados: Las intervenciones de prevención de caídas en pacientes geriátricos en residencias geriátricas y unidades de larga estancia reducen de forma global la posibilidad de caerse en OR: 0,63, IC 95%: 0,53-0,74. Becker realizó una intervención de prevención de caídas en donde disminuía la posibilidad de caída en OR: 0,53, IC 95%: 0,41-0,69. Conclusiones: La realización de intervenciones de prevención de caídas en residencias geriátricas y unidades de larga estancia disminuye 1,58 veces la posibilidad de caerse. La formación del equipo aparece como un aspecto clave en la prevención de caídas en los estudios analizados. La prevención de caídas en el anciano institucionalizado requiere un enfoque multifactorial, interdisciplinario e individualizado

Introduction: Falls are the most common type of accidents among elder people and, as scientifical evidences show, between 50 and 60% of the elderly who are resident on nursing health care institutions fall once a year. Complications regarding this matter are the main cause of accidental death and the sixth cause of death of adults older than 65. Preventing such kind of accidents is a prior objective in all fields concerning nursing cares to older adults and specially in nursing care institutions or in long care institutions. Professionals who work in direct care need to determine the problem causes y to value the efficiency and effectiveness of multiple prevention actions that are actually engaged interdisciplinary. As a result of this collaboration some investigation works are being developed and their results are to be published. Objectives: To demonstrate the interest of such question for all professionals who work on this field, and to analyze the most effective prevention actions actually running, we propose to review systematically all scientific studies published during the last 15 years, worldwide and without language limitation, about different fall prevention actions on older adults who are living in nursing care or long care institutions. Methods: The study population is formed by randomized clinical trials about primary prevention interventions of falls, on old adults patients residents in nursing care or long care institutions, published during the last 15 years worldwide and without language limitation. For the research, 24 scientific databases have been checked. Besides, some bibliographic catalogues, expert consultations and Internet searching engines, have been used. The researching team reviewed an amount of 2,382 studies, from which 156 have been analyzed. Finally, 7 of the analyzed studies have been selected (this seven have been blanked), after examining their methodological quality through the Checklist of Consort Statement (2002). A descriptive analysis has been made, to obtain some information regarding the matter, and afterwards a goal analysis was made too. This analysis was made to establish the effectiveness of the interventions related to falls prevention. Results: Interventions of falls prevention on older adults residents in nursing care or long care institutions, reduce globally falling possibilities in OR: 0.63, IC 95%: 0.53-0.74. Becker set an intervention on falls prevention where falling possibilities decreased in OR: 0,53; IC 95%: 0.41-0.69. Conclusions: The setting of a plan or guidelines for the intervention regarding falls prevention in nursing care and long care institutions reduces 1.58 times the possibilities for older adults to fall. Team training appears to be a main aspect in falls prevention in the analyzed works and papers. Falling prevention on care institutions requires a multifactor, interdisciplinary and individualized approach

A test battery for the ecotoxicological evaluation of pentachlorophenol.

Experimental bioassays are currently used in ecotoxicology and environmental toxicology to provide information for risk assessment evaluation of new chemicals and to investigate their effects and mechanisms of action; in addition, ecotoxicological models are used for the detection, control and monitoring of the presence of pollutants in the environment. As a single bioassay will never provide a full picture of the quality of the environment, a representative, cost-effective and quantitative test battery should be developed. The effects of pentachlorophenol were studied using a battery of ecotoxicological model systems, including immobilization of Daphnia magna, bioluminiscence inhibition in the bacterium Vibrio fischeri, growth inhibition of the alga Chlorella vulgaris, and micronuclei induction in the plant Allium cepa. The inhibition of cell proliferation and MTT reduction were investigated in Vero cells. Neutral red uptake, cell growth, MTT reduction, lactate dehydrogenase leakage and activity were studied in the salmonid fish cell line RTG-2, derived from the gonad of rainbow trout. Pentachlorophenol was very toxic for all biota and cells. The system most sensitive to pentachlorophenol, was micronuclei induction in A. cepa, followed by D. magna immobilization, bioluminescence inhibition in V. fischeri bacteria at 60 min and cell proliferation inhibition of RTG-2 cells at 72 h. Inhibition of cell proliferation and MTT reduction on Vero monkey cells showed intermediate sensitivity.

[Bronchial asthma. Its pattern in 2 rural areas]. / Asma bronquial. Comportamiento en 2 zonas rurales.

A survey was carried out in order to determine if bronchial asthma represents a health problem in two rural areas under the medical assistance of family doctors' offices (Argeo Martínez and Manguito del Guaso). All the case histories in the zones under study were reviewed. It was found that, in spite of the low prevalence in both areas, there is a diseased for each 28 persons, being female the most affected.