ABSTRACT
Pediatricians need to be knowledgeable to adequately carry out their role in the support of breastfeeding, so assessing their knowledge of breastfeeding is vitally important. There are not English language validated questionnaires for pediatricians in the literature; however, in Spanish and Portuguese, there is the Breastfeeding Knowledge Survey (ECoLa, derived from Encuesta de Conocimientos en Lactancia). Our goal is to translate the ECoLa into English. The original survey consisted of true/false questions, including one with an image of a breastfeeding baby, multiple-choice questions featuring clinical cases, and two open-ended short questions. We used a translation approach that incorporated both forward and backward translations and a multidisciplinary committee to evaluate the translation process. During translation, four Spanish versions and seven English versions were considered prior to consensus approval of the final survey. The intraclass correlation coefficient between the English questionnaire and the original Spanish version was 0.85 (95% CI [0.60, 0.95]). A sample of 51 participants completed the survey, resulting in a Cronbach's alpha of 0.78 for the English version (95% CI [0.70, 0.86]). The Breastfeeding Knowledge Survey is now accessible under a Creative Commons license, permitting its free re-use.
ABSTRACT
The randomized clinical trial (RCT) is the ideal and mandatory type of study to verify the effect and safety of a drug. Our aim is to examine the fundamental characteristics of interventional clinical trials on influenza and respiratory syncytial virus (RSV). This is a cross-sectional study of RCTs on influenza and RSV in humans between 2014 and 2021 registered in ClinicalTrials.gov. A total of 516 studies were identified: 94 for RSV, 423 for influenza, and 1 for both viruses. There were 51 RCTs of RSV vaccines (54.3%) and 344 (81.3%) for influenza virus vaccines (p < 0.001). Twelve (12.8%) RCTs for RSV were conducted only with women, and 6 were conducted only with pregnant women; for RCTs for influenza, 4 (0.9%) and 3, respectively. For RSV, 29 (31%) of the RCTs were exclusive to people under 5 years of age, and 21 (5%) for influenza virus (p < 0.001). For RSV, there are no RCTs exclusively for people older than or equal to 65 years and no phase 4 trials. RCTs on influenza virus and RSV has focused on vaccines. For the influenza virus, research has been consolidated, and for RSV, research is still in the development phase and directed at children and pregnant women.
Subject(s)
Influenza Vaccines , Influenza, Human , Orthomyxoviridae , Respiratory Syncytial Virus Infections , Child, Preschool , Female , Humans , Infant , Pregnancy , Cross-Sectional Studies , Influenza, Human/prevention & control , Randomized Controlled Trials as Topic , Respiratory Syncytial Virus Infections/prevention & control , Respiratory Syncytial VirusesABSTRACT
OBJECTIVE: Primary Care (PC) must attend and follow COVID-19 patients with mild and moderate symptoms, and identify severe cases. The aim of this study was to describe the characteristics of patients attended in PC with suspicious COVID-19 and health care provision by PC. METHODS: Retrospective longitudinal observational study of electronic health records (EHR) and agendas. Probabilistic sampling of suspicious COVID-19 patients' pathway in 5 health centers in Madrid between March 16 and 20, 2020. The variables used were sociodemographic, symptoms, examination, radiography, characteristics of schedules and professional sick leaves. Descriptive analysis and time to event (pneumonia). RESULTS: 240 EHR were reviewed. Average age 48 years, 60% women. Most frequent symptoms: cough (80%) and elevation of temperature (63%). Pneumonia appeared in 23%. 73% were bilateral. Age and male gender were related to pneumonia. 20% required admission. 7 patients died (2.9%). 19,027 COVID-19 appointments were scheduled in PC. 60% of patients were attended in PC without performing chest X-ray or assistance by other care level. 22.4% of GPs working days were absent because of sick leaves. Differences were found amongst facilities in chest X-ray requesting (max. 62%, min. 2%). The PC center with the fewest X-rays requested was the one with the major number of sick leaves. CONCLUSIONS: Age and male gender were related to pneumonia onset in PC. Health care activity was intense, and variability was found amongst facilities. Professional sick leaves could affect the quality of care.
OBJETIVO: La Atención Primaria (AP) debe atender y hacer un seguimiento a pacientes COVID-19 con cuadros leves y moderados, e identificar casos graves. El objetivo del estudio fue describir las características de los pacientes atendidos en AP con sospecha de COVID-19 y la provisión de atención sanitaria en AP. METODOS: Estudio observacional longitudinal retrospectivo de historias clínicas y agendas. Muestreo probabilístico de pacientes atendidos en el circuito de sospecha de COVID-19 en 5 centros de salud en Madrid entre el 16 y 20 de marzo 2020. Las variables utilizadas fueron sociodemográficas, síntomas, exploración, radiografía, características de las agendas y de las ausencias de profesionales. Análisis descriptivo y de tiempo hasta evento (neumonía). RESULTADOS: Se revisaron 240 historias. Edad media 48 años, 60% mujeres. Síntomas más frecuentes: tos (80%) y elevación de temperatura (63%). Apareció neumonía en el 23%. El 73% fueron bilaterales. La edad y el sexo masculino se relacionaron con la aparición de neumonía. Precisó ingreso el 20%. Fallecieron 7 pacientes (2,9%). Se atendieron 19.027 citas. El 60% de pacientes fue atendido en AP sin radiografía ni valoración por otro nivel asistencial. Fueron baja laboral el 22,4% de las jornadas de Medicina. Hubo diferencias entre centros en la realización de radiografías (máximo 62%, mínimo 2%), el centro con menos radiografías solicitadas fue el que más bajas laborales presentó (41,3%). CONCLUSIONES: La edad y sexo masculino se correlacionaron con la aparición de neumonía en AP. La actividad asistencial fue intensa y se identificó variabilidad entre centros. Las bajas profesionales pudieron afectar a la calidad de la atención.
Subject(s)
COVID-19 , Delivery of Health Care , Female , Humans , Male , Middle Aged , Primary Health Care , Retrospective Studies , SARS-CoV-2 , SpainABSTRACT
Fundamentos: La Atención Primaria (AP) debe atender y hacer un seguimiento a pacientes COVID-19 con cuadros leves y moderados, e identificar casos graves. El objetivo del estudio fue describir las características de los pacientes atendidos en AP con sospecha de COVID-19 y la provisión de atención sanitaria en AP. Métodos: Estudio observacional longitudinal retrospectivo de historias clínicas y agendas. Muestreo probabilístico de pacientes atendidos en el circuito de sospecha de COVID-19 en 5 centros de salud en Madrid entre el 16 y 20 de marzo 2020. Las variables utilizadas fueron sociodemográficas, síntomas, exploración, radiografía, características de las agendas y de las ausencias de profesionales. Análisis descriptivo y de tiempo hasta evento (neumonía). Resultados: Se revisaron 240 historias. Edad media 48 años, 60% mujeres. Síntomas más frecuentes: tos (80%) y elevación de temperatura (63%). Apareció neumonía en el 23%. El 73% fueron bilaterales. La edad y el sexo masculino se relacionaron con la aparición de neumonía. Precisó ingreso el 20%. Fallecieron 7 pacientes (2,9%). Se atendieron 19.027 citas. El 60% de pacientes fue atendido en AP sin radiografía ni valoración por otro nivel asistencial. Fueron baja laboral el 22,4% de las jornadas de Medicina. Hubo diferencias entre centros en la realización de radiografías (máximo 62%, mínimo 2%), el centro con menos radiografías solicitadas fue el que más bajas laborales presentó (41,3%). Conclusiones: La edad y sexo masculino se correlacionaron con la aparición de neumonía en AP. La actividad asistencial fue intensa y se identificó variabilidad entre centros. Las bajas profesionales pudieron afectar a la calidad de la atención.(AU)
Background: Primary Care (PC) must attend and follow COVID-19 patients with mild and moderate symptoms, and identify severe cases. The aim of this study was to describe the characteristics of patients attended in PC with suspicious COVID-19 and health care provision by PC. Methods: Retrospective longitudinal observational study of electronic health records (EHR) and agendas.Probabilistic sampling of suspicious COVID-19 patients pathway in 5 health centers in Madrid between March 16 and 20, 2020. The variables used were sociodemographic, symptoms, examination, radiography, characteristics of schedules and professional sick leaves. Descriptive analysis and time to event (pneumonia). Results: 240 EHR were reviewed. Average age 48 years, 60% women. Most frequent symptoms: cough (80%) and elevation of temperature (63%). Pneumonia appeared in 23%. 73% were bilateral. Age and male gender were related to pneumonia. 20% required admission. 7 patients died (2.9%). 19,027 COVID-19 appointments were scheduled in PC. 60% of patients were attended in PC without performing chest Xray or assistance by other care level. 22.4% of GPs working days were absent because of sick leaves. Differences were found amongst facilities in chest Xray requesting (max. 62%, min. 2%). The PC center with the fewest Xrays requested was the one with the major number of sick leaves. Conclusions: Age and male gender were related to pneumonia onset in PC. Health care activity was intense, and variability was found amongst facilities. Professional sick leaves could affect the quality of care.(UA)
Subject(s)
Humans , Pandemics , Primary Health Care , Coronavirus Infections , Betacoronavirus , Severe acute respiratory syndrome-related coronavirus , Supply , Medical Records , Pneumonia/complications , Pneumonia/diagnosis , Quality of Health Care , Longitudinal Studies , Retrospective Studies , Public Health , Spain , EpidemiologyABSTRACT
BACKGROUND: Possible cases of SARS-CoV-2 infection were diagnosed in primary care in Madrid, some of these cases had pneumonia. Most of the SARS-CoV-2 pneumonia published data came from hospitalised patients. This study set out to describe clinical characteristics of patients with SARS-CoV-2 pneumonia diagnosed in primary care across age groups and type of pneumonia. METHODS: Observational retrospective study obtaining clinical data from the electronic health records of patients who were followed-up by SARS-CoV-2 possible infection in a primary care practice in Madrid. All the cases were collected by in-person or remote consultation during the 10th March to the 7th of April. EXPOSURE: Diagnosis of SARS-CoV-2 pneumonia by chest X-ray ordered by the GP. Main outcomes and measures: Symptoms of SARS-CoV-2 pneumonia, physical examination and diagnostic tests as a blood test, nasopharyngeal swab results for RT-PCR (Reverse transcriptase-polymerase chain reaction) and chest X-ray results. RESULTS: The overall SARS-CoV-2 pneumonias collected were 172 (female 87 [50.6%], mean age 60.5 years standard deviation [SD] 17.0). Comorbidities were body mass index ≥ 25 kg/m2 (90 [52.3%]), hypertension (83 [48.3%]), dyslipidaemia (68 [39.5%]) and diabetes (33 [19.2%]). The sample was stratified by age groups (< 50 years, 50-75 years and ≥ 75 years). Clinical manifestations at onset were fever (144 [83.7%]), cough (140 [81.4%]), dyspnoea (103 [59.9%]) and gastrointestinal disturbances (72 [41.9%]). Day 7.8 (SD:4.1) from clinical onset was the mean day of pneumonia diagnosis. Bilateral pneumonia was more prevalent than unilateral (126 [73.3%] and 46 [26.7%]). Patients with unilateral pneumonia were prone to higher pulse oximetry (96% vs 94%, p < 0.001). We found differences between unilateral and bilateral cases in C-reactive protein (29.6 vs 81.5 mg/L, p < 0.001), and lymphocytes (1400.0 vs 1000.0E3/ml, p < 0.001). Complications were registered: 42 (100%) of patients ≥ 75 years were admitted into hospital; pulmonary embolism was only present at bilateral pneumonia (7 patients [5.6%]) and death occurred in 1 patient with unilateral pneumonia (2.2%) vs 10 patients (7.9%) with bilateral pneumonia ( p 0.170). CONCLUSION: Clinical manifestations of SARS-CoV-2 pneumonia were fever, cough and dyspnoea; this was especially clear in the elderly. We described different characteristics between unilateral and bilateral pneumonia.
Subject(s)
COVID-19 , Lung/diagnostic imaging , Pneumonia, Viral , Primary Health Care , SARS-CoV-2/isolation & purification , Symptom Assessment , Age Factors , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19 Testing/methods , Causality , Electronic Health Records/statistics & numerical data , Female , Humans , Male , Middle Aged , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Radiography, Thoracic/methods , Radiography, Thoracic/statistics & numerical data , Retrospective Studies , Spain/epidemiology , Symptom Assessment/methods , Symptom Assessment/statistics & numerical dataABSTRACT
OBJECTIVE: Increasing breastfeeding rates is a desirable goal for improving maternal and child health. Pediatricians have a main role in this subject. The objective was to document breastfeeding knwoledge in Pediatric residents, and its relationship with the BFHI (Baby Friendly Hospital Initiative) status of their hospitals. METHODS: Transversal study with a validated online survey (ECoLa). Polietapic sampling of Pediatric residentes in Spain by strata (BFHI degree) and clusters (hospitals). Estimated sample size was 142 residents. 312 surveys were sent to 21 hospitals. Main variable was the percentage of correct answers to survey questions, it was analyzed with non parametric techniques. RESULTS: 189 answers (response rate 60%). Global median (Me) of correct answers was 76.9% (95% Confidence Interval [95CI] 74.2-79.6). There was no difference among first and second year residents (Me=76.9%) and third and fourth year residents (Me=73.1%) (p=0.541). Residents from BFHI hospitals (Me=84.6%) achieved better results than those from non-BFHI hospitals (Me=73.1%) (p=0.002). Variability at non-BFHI hospitals was considerable, where some hospitals showed unacceptable scores. Prevalence of courses was greater at BFHI hospitals (95% vs 52%). CONCLUSIONS: There are some deficiencies in Pediatric residents' breastfeeding training. There are hospitals whose residents have an insufficient breastfeeding knowledge. No low scores were found in residents from BFHI hospitals. We consider neccesary to systematize and universalize breastfeeding training during Pediatric Residency.
OBJETIVO: Una de las metas para mejorar la salud materno-infantil es aumentar las tasas de lactancia, y la Pediatría tiene un papel fundamental en ello. El objetivo del estudio fue averiguar el nivel de conocimientos sobre lactancia materna de los residentes de Pediatría y su relación con la acreditación IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia). METODOS: Se realizó un estudio transversal mediante encuesta validada (ECoLa) de cumplimentación online. Se elaboró un muestreo por estratos y conglomerados de los residentes de Pediatría en España. El tamaño muestral necesario fue de 142 sujetos. Se enviaron 315 encuestas a 21 hospitales. La variable principal fue el porcentaje de aciertos a las preguntas de la encuesta, que se evaluó con técnicas no paramétricas. RESULTADOS: Hubo 189 respuestas (tasa de respuesta del 60%). La Mediana (Me) global de aciertos fue del 76,9% (Intervalo de Confianza al 95%=[IC95] 74,2-79,6). La mediana de aciertos no difirió entre residentes de primer y segundo año (Me=76,9%) y los de tercer y cuarto año (Me=73,1%) (p=0,541). Los residentes de los hospitales acreditados por la IHAN (Me=84,6%) obtuvieron mejores resultados que los de hospitales no acreditados (Me=73,1%) (p=0,002). En los hospitales no acreditados, la variabilidad de conocimientos fue amplia, con puntuaciones muy bajas en algunos de ellos. El porcentaje de residentes que había realizado cursos específicos fue muy superior en los hospitales acreditados por la IHAN (95% vs 52%). CONCLUSIONES: Se detectan lagunas en la formación en lactancia de los residentes de Pediatría. Existen hospitales cuyos residentes tienen unos conocimientos en la materia claramente insuficientes, aunque no se hallan carencias en residentes de hospitales acreditados por la IHAN. Consideramos necesario universalizar y sistematizar la formación en lactancia.
Subject(s)
Attitude to Health , Breast Feeding/statistics & numerical data , Health Promotion/methods , Hospitals/statistics & numerical data , Pediatrics/standards , Adult , Cross-Sectional Studies , Female , Humans , Internship and Residency , Male , Mothers , Prevalence , Spain/epidemiology , Surveys and Questionnaires , Young AdultABSTRACT
PURPOSE: Heart failure (HF) is a chronic, frequent and disabling condition but with a modifiable course and a large potential for improving. The aim of this study was to validate the two available clinical prediction rules for mortality at one year in patients with primo-hospitalization for decompensated HF: PREDICE and AHEAD. The secondary aim was to evaluate in our setting the changes in the clinical pattern of HF in the last decade in patients hospitalized for a first episode of the disease. PATIENTS AND METHODS: A prospective multicenter cohort study, which included 180 patients hospitalized with "de novo" HF was conducted to validate the PREDICE score. Calibration and discrimination measurements were calculated for the PREDICE model and the PREDICE score (using the validation cohort of the PREDICE) and the AHEAD score (using both the development and the validation cohort of the PREDICE). RESULTS: For the PREDICE models, the area under the curve (AUC) was 0.68 (95% confidence interval [CI]: 0.57-0.79) and the calibration slope 0.65 (95% CI: 0.21-1.20). For the PREDICE score AUC was 0.59 (95% CI: 0.47-0.71) and slope 0.42 (95% CI: -0.20-1.17). For the AHEAD score the AUC was 0.68 (95% CI: 0.62-0.73) and slope 1.38 (95% CI: 0.62-0.73) when used the development cohort of PREDICE and the AUC was 0.58 (95% CI: 0.49-0.67), and slope 0.68 (95% CI: -0.06 to 1.47) when used its validation cohort. CONCLUSION: The present study shows that the two risk scores available for patients with primo-hospitalization for decompensated HF (PREDICE and AHEAD) are not currently valid for predicting mortality at one-year. In our setting the clinical spectrum of hospitalized patients with new-onset HF has been modified over time. The study underscores the need to validate the prognostic models before clinical implementation.
ABSTRACT
OBJETIVO: Una de las metas para mejorar la salud materno-infantil es aumentar las tasas de lactancia, y la Pediatría tiene un papel fundamental en ello. El objetivo del estudio fue averiguar el nivel de conocimientos sobre lactancia materna de los residentes de Pediatría y su relación con la acreditación IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia). MÉTODOS: Se realizó un estudio transversal mediante encuesta validada (ECoLa) de cumplimentación online. Se elaboró un muestreo por estratos y conglomerados de los residentes de Pediatría en España. El tamaño muestral necesario fue de 142 sujetos. Se enviaron 315 encuestas a 21 hospitales. La variable principal fue el porcentaje de aciertos a las preguntas de la encuesta, que se evaluó con técnicas no paramétricas. RESULTADOS: Hubo 189 respuestas (tasa de respuesta del 60%). La Mediana (Me) global de aciertos fue del 76,9% (Intervalo de Confianza al 95%=[IC95] 74,2-79,6). La mediana de aciertos no difirió entre residentes de primer y segundo año (Me=76,9%) y los de tercer y cuarto año (Me=73,1%) (p = 0,541). Los residentes de los hospitales acreditados por la IHAN (Me=84,6%) obtuvieron mejores resultados que los de hospitales no acreditados (Me=73,1%) (p = 0,002). En los hospitales no acreditados, la variabilidad de conocimientos fue amplia, con puntuaciones muy bajas en algunos de ellos. El porcentaje de residentes que había realizado cursos específicos fue muy superior en los hospitales acreditados por la IHAN (95% vs 52%). CONCLUSIONES: Se detectan lagunas en la formación en lactancia de los residentes de Pediatría. Existen hospitales cuyos residentes tienen unos conocimientos en la materia claramente insuficientes, aunque no se hallan carencias en residentes de hospitales acreditados por la IHAN. Consideramos necesario universalizar y sistematizar la formación en lactancia
OBJECTIVE: Increasing breastfeeding rates is a desirable goal for improving maternal and child health. Pediatricians have a main role in this subject. The objective was to document breastfeeding knwoledge in Pediatric residents, and its relationship with the BFHI (Baby Friendly Hospital Initiative) status of their hospitals. METHODS: Transversal study with a validated online survey (ECoLa). Polietapic sampling of Pediatric residentes in Spain by strata (BFHI degree) and clusters (hospitals). Estimated sample size was 142 residents. 312 surveys were sent to 21 hospitals. Main variable was the percentage of correct answers to survey questions, it was analyzed with non parametric techniques. RESULTS: 189 answers (response rate 60%). Global median (Me) of correct answers was 76.9% (95% Confidence Interval [95CI] 74.2-79.6). There was no difference among first and second year residents (Me=76.9%) and third and fourth year residents (Me=73.1%) (p = 0.541). Residents from BFHI hospitals (Me=84.6%) achieved better results than those from non-BFHI hospitals (Me=73.1%) (p = 0.002). Variability at non-BFHI hospitals was considerable, where some hospitals showed unacceptable scores. Prevalence of courses was greater at BFHI hospitals (95% vs 52%). CONCLUSIONS: There are some deficiencies in Pediatric residents' breastfeeding training. There are hospitals whose residents have an insufficient breastfeeding knowledge. No low scores were found in residents from BFHI hospitals. We consider neccesary to systematize and universalize breastfeeding training during Pediatric Residency
Subject(s)
Humans , Male , Female , Young Adult , Adult , Attitude to Health , Breast Feeding/statistics & numerical data , Health Promotion/methods , Hospitals/statistics & numerical data , Pediatrics/standards , Cross-Sectional Studies , Internship and Residency , Mothers , Prevalence , Spain/epidemiology , Surveys and QuestionnairesABSTRACT
PURPOSE: Erlotinib and gefitinib are both tyrosine kinase inhibitors (TKIs) approved for the treatment of non-small cell lung cancer (NSCLC). Although it is well known that the increase of gastric pH may decrease the solubility of TKIs, there is limited evidence about the clinical repercussion of this fact. The purpose of this study was to determine if the use of gastric acid suppressive therapy (As) concomitantly with TKIs has an adverse impact on progression-free survival (PFS) and to determine whether the type of drug used (proton pump inhibitors/PPIs or histamine-2 receptors antagonists (H2RAs) may influence it. METHODS: In this retrospective observational study included were patients treated for ≥1 week with erlotinib or gefitinib from January 2012 to December 2015. Demographic, diagnostic and therapeutic variables were collected. Patients were divided into two groups (As users and non-As users). For the calculation of the PFS the Kaplan Meier and multivariate Cox regression analysis were used. RESULTS: 163 patients with mean age 70 years were included. 72.397percnt; (n=118) received TKIs and As concomitantly. The mean PFS was 84 days (95% CI, 65-101) and 221 days (95% CI, 125-429; p <0.0001) in As users and non-As users, respectively. Regarding the type of As used, no significant differences were observed. CONCLUSION: Concomitant use of As and TKIs adversely impacted the PFS outcomes in NSCLC patients regardless of the type of As used. Further studies are needed to determine the clinical impact of interactions between antiacids and antineoplastics.
Subject(s)
Gastric Acid/metabolism , Lung Neoplasms/drug therapy , Protein Kinase Inhibitors/therapeutic use , Adult , Aged , Aged, 80 and over , Disease-Free Survival , Erlotinib Hydrochloride/therapeutic use , Female , Gefitinib/therapeutic use , Humans , Hydrogen-Ion Concentration , Lung Neoplasms/metabolism , Lung Neoplasms/pathology , Male , Middle Aged , Retrospective StudiesABSTRACT
It has often been suggested that cardiovascular mortality and their geographical heterogeneity are associated with nutrients intake patterns and also lipid profile. The large Spanish study Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) investigated this theory from 1991 to 2010. Out of the 4,783 Spanish individuals making up the DRECE cohort, 220 subjects (148 men and 72 women) died (4.62%) during the course of the study. The mean age of patients who died from cardiovascular causes (32 in all) was 61.08 years 95% CI (57.47-64.69) and 70.91% of them were males. The consumption of nutrients and the lipid profile by geographical area, studied by geospatial models, showed that the east and southern area of the country had the highest fat intake coupled to a high rate of unhealthy lipid profile. It was concluded that the spatial geographical analysis showed a relationship between high fat intake, unhealthy lipid profile and cardiovascular mortality in the different geographical areas, with a high variability within the country.
