The effect of physical activity on asthma incidence over 10†years: population-based study.

Although there are many health benefits from being active, there was no benefit observed in this study from vigorous physical activity in reducing the risk of asthma onset in middle-aged adults https://bit.ly/3bEtHDn.

Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM / Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry

Objetivo: Describir las características de la gestión de casos en cuanto a población atendida, intervenciones, utilización de servicios y los desenlaces mortalidad, reingresos, úlceras por presión, caídas, problemas con medicamentos e institucionalización. Método: Estudio de seguimiento de una cohorte a partir del registro multicéntrico RANGECOM de Andalucía. La población de estudio son pacientes atendidos en la cartera de servicios de gestión de casos de centros de salud y sus cuidadores familiares. Resultados: Se presentan datos de 835 pacientes con edad media de 76,8años (DE:12,1), un 50,24% mujeres. Presentan una comorbilidad importante (Charlson 3,1; DE:2,5) y dependencia elevada (Barthel 37,5; DE:31,4). El 60,2% de las intervenciones desplegadas por las gestoras de casos se aglutina en tres dominios: conductual (26,0%), sistema sanitario (20,2%) y seguridad (14,1%). La mortalidad fue del 34,4% y los ingresos hospitalarios, del 38,1%. Los pacientes con más reingresos hospitalarios tenían más visitas a urgencias (OR:1,41; IC95%: 1,22-1,63), más intervenciones telefónicas de las gestoras de casos (OR:1,12; IC95%: 1,02-1,24) y pruebas de imagen (OR:1,37; IC95%: 1,17-1,60), junto con un mayor cansancio en la cuidadora (OR:1,31; IC95%: 1,08-1,59), la presencia de dispositivos médicos en domicilio (OR:1,69; IC95%: 1,00-2,87) y recibían menos la intervención «Gestión de Casos». Conclusiones: Los pacientes que absorben la demanda de las enfermeras gestoras de casos presentan una alta complejidad, frente a la cual despliegan intervenciones conductuales, de navegación por el sistema sanitario y de seguridad clínica

Objective: To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. Method: Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. Results: Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. Conclusions: The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry. / Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM.

OBJECTIVE: To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. METHOD: Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. RESULTS: Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. CONCLUSIONS: The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Guía para el abordaje de los cuidados a personas con EPOC en Atención Primaria en el SSPA

Documento en el que se proponen una serie de recomendaciones que pretenden disminuir la variabilidad de la práctica clínica y ofrecer a los enfermeros y enfermeras de atención primaria, un referente en su práctica asistencial durante todo el proceso de atención que precisa un paciente con Enfermedad Pulmonar Obstructiva Crónica (EPOC).

Factores predictores de deterioro cognitivo en población mayor de 64 años institucionalizada y no institucionalizada / Predictors of cognitive impairment in population over 64 years institutionalized and non-institutionalized

OBJETIVO: Describir los factores que puedan asociarse con deterioro cognitivo en personas mayores institucionalizadas y no institucionalizadas. MÉTODO: Estudio transversal a 200 personas mayores de 64 años en Huelva (España) en 2014. De ellas, 100 personas estaban institucionalizadas en un centro residencial y 100 no institucionalizadas. Se evaluó el deterioro cognitivo mediante el Mini-Mental State Examination (Mec-35), las actividades básicas para la vida diaria mediante el índice de Barthel, la salud general a través del Goldberg GHQ-28 y variables de tipo social, clínico y conductual. Se analizó asociación del deterioro cognitivo con todas las variables mediante ji cuadrado. Finalmente se realizó un análisis multivariante mediante regresión logística, para identificar la asociación conjunta de las variables a estudio con el deterioro cognitivo. RESULTADOS: La prevalencia de deterioro cognitivo en institucionalizados fue del 47%, superior a la de los no institucionalizados que fue del 8% (p< 0,001). La dependencia para las actividades básicas para la vida diaria y las actividades didácticas fueron las únicas variables que en ambos grupos se asociaron con el deterioro cognitivo. La institucionalización (OR= 5,368), la edad (OR= 1,066) y la dependencia para las actividades básicas para la vida diaria (OR= 5,036), se asociaron de forma negativa con el deterioro cognitivo, mientras que las actividades didácticas (OR= 0,227) se asociaron de forma positiva. CONCLUSIONES: La realización de actividades didácticas y el fomento de la autonomía personal puede retrasar la aparición del deterioro cognitivo. Es importante incluir programas de estimulación cognitiva dirigidos a la población mayor, especialmente en las instituciones residenciales

AIM: Describe the factors which can be associated with cognitive impairment in institutionalized and non-institutionalized elderly. Method: Cross-sectional study of 200 people aged over 64 in Huelva (Spain) in 2014. Of these, 100 people were institutionalized in a residential facility and 100 were not. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE-35), basic activities of daily living by Barthel index, general health through the Goldberg GHQ-28 and social, clinical and behavioural variables were contemplated in the study. The association of cognitive impairment with all the variables was analysed using Chi-square test. Finally, a multivariate analysis was performed using logistic regression to identify possible joint influence of variables to study on the cognitive impairment. RESULTS: The prevalence of cognitive impairment in those institutionalized was 47%, higher than that of non-institutionalized group which was only 8% (p < .001). The dependence for basic activities for daily living and learning activities were the only variables in both groups which were associated with the cognitive impairment. Institutionalization (OR = 5.368), age (OR = 1.066) and dependence for basic activities (OR = 5.036) were negatively associated with CI, while learning activities (OR = .227) were associated in a positive way. CONCLUSIONS: Conducting learning activities and the promotion of personal autonomy can delay cognitive impairment in older people. It is important to include cognitive stimulation programs aimed at the old population, especially in residential institutions

[Predictors of cognitive impairment in population over 64 years institutionalized and non-institutionalized]. / Factores predictores de deterioro cognitivo en población mayor de 64 años institucionalizada y no institucionalizada.

AIM: Describe the factors which can be associated with cognitive impairment in institutionalized and non-institutionalized elderly. METHOD: Cross-sectional study of 200 people aged over 64 in Huelva (Spain) in 2014. Of these, 100 people were institutionalized in a residential facility and 100 were not. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE-35), basic activities of daily living by Barthel index, general health through the Goldberg GHQ-28 and social, clinical and behavioural variables were contemplated in the study. The association of cognitive impairment with all the variables was analysed using Chi-square test. Finally, a multivariate analysis was performed using logistic regression to identify possible joint influence of variables to study on the cognitive impairment. RESULTS: The prevalence of cognitive impairment in those institutionalized was 47%, higher than that of non-institutionalized group which was only 8% (p<.001). The dependence for basic activities for daily living and learning activities were the only variables in both groups which were associated with the cognitive impairment. Institutionalization (OR=5.368), age (OR=1.066) and dependence for basic activities (OR=5.036) were negatively associated with CI, while learning activities (OR=.227) were associated in a positive way. CONCLUSIONS: Conducting learning activities and the promotion of personal autonomy can delay cognitive impairment in older people. It is important to include cognitive stimulation programs aimed at the old population, especially in residential institutions.

Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

RATIONALE, AIMS AND OBJECTIVES: Complex chronic diseases are a challenge for the current configuration of health services. Case management is a service frequently provided for people with chronic conditions, and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers and services used. METHODS: The study was divided into three phases, covering the detection of information needs, the design and its implementation in the health care system, using literature review and expert consensus methods to select variables that would be included in the registry. RESULTS: A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. A web-based registry with modular and layered architecture was designed. The framework follows a pattern based on the model-view-controller approach. In its first 6 months after the implementation, 102 case managers have introduced an average number of 6.49 patients each one. CONCLUSIONS: The registry permits a complete and in-depth analysis of the characteristics of the patients who receive case management, the interventions delivered and some major outcomes as mortality, readmissions or adverse events.

Oxigenoterapia domiciliaria provisional y organización asistencial / No disponible

No disponible

[Research lines proposed by Andalusian Association of Community Nursing]. / Líneas de investigación propuestas por la Asociación de Enfermería Comunitaria de Andalucía.

OBJECTIVE: To define and prioritise the future research lines of the Andalusian Association of Community Nursing (ASANEC). METHOD: Application of the Delphi technique within the members of the Working Group of the Research area of ASANEC, consisting of Community nurses from clinical and educational settings, as regards research in seven Andalusian provinces. Three rounds of participation were performed, with the last one being prioritised using a Linear Scale. Averages and standard deviations have been calculated. RESULTS: The total number of participants on this technique was 13 professionals (54.16%). The main research lines finally agreed and prioritised, were the following, in decreasing order: «care management¼, «quality of life¼, «lifestyles and health education in children and adolescent population¼, «design and validation of nursing assessment tools¼, «patient safety¼, «accessibility to healthcare services and development of self-care capacity¼. CONCLUSIONS: Research on the new model of care management introduced into Andalusian primary care was given priority, although there are more emerging research lines related to Health Promotion and Prevention of Health problems in the general population, children, young people and vulnerable populations. These results have been the deciding factors in the choice of the current research lines developed by the ASANEC Research Group.