ABSTRACT
Not so long ago stomach cancer used to be the most frequent digestive cancer in both sexes in Spain and other Western countries. However, due to the decreasing trend of this disease over the last few decades, gastric cancer ranks seventh and eighth in Spanish women and men, respectively, as a cancer-related cause of death, while being the fourth most frequent digestive cancer, after colorectal, pancreatic and liver cancer. On the other hand, pancreatic cancer mortality figures have been continually increasing, and nowadays this malignancy ranks second among digestive cancers in terms of mortality in both sexes. The distinct trends of stomach and pancreatic cancer mortality rates might be explained by changes in exposure to risk factors, mainly to H. pylori eradication. Notably, these tumors share several modifiable risk factors, such as tobacco consumption, obesity, and physical inactivity. Since these risk factors are also associated with many other cancers, effective cancer prevention strategies are needed to reduce the risk of developing cancer in the population.
Subject(s)
Pancreatic Neoplasms , Stomach Neoplasms , Humans , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/epidemiology , Spain/epidemiology , Stomach Neoplasms/mortality , Male , Female , Risk Factors , Mortality/trendsABSTRACT
OBJETIVOS: describir conocimientos y percepciones de profesionales de Atención Primaria sobre el acceso al Sistema Nacional de Salud (SNS) y la atención sanitaria de la población inmigrante, así como analizar diferencias entre categorías profesionales. MÉTODOS: se realizó un estudio observacional descriptivo transversal mediante una encuesta a 352 profesionales sanitarios y no sanitarios en centros de salud de la Comunidad de Madrid, y residentes de Medicina y Enfermería de la Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Sur de Madrid (UDMAFyC Sur) entre febrero y marzo de 2019. RESULTADOS: respondieron 179 profesionales (50,9%). El 50,3% opinó que los inmigrantes tienen frecuentes dificultades de acceso y el 65,9% que el estatus migratorio condiciona su salud, señalando el idioma como barrera relevante el 80,4%. El 72,7% de los sanitarios afirmó que no consumen más recursos. Expresaron nulo/escaso conocimiento del Real Decreto-Ley (RDL) 16/2012 el 72%, y del RDL 7/2018, un 66,7%. Un 30,7% consideró que el RDL 16/2012 tuvo efectos negativos en salud, y el 28,5%, que el RDL 7/2018 recuperó la universalidad. Un 54,9% de sanitarios apoyó la universalidad del SNS, contrastando con el 19,1% de personal no sanitario. CONCLUSIONES: la mitad de profesionales percibe frecuentes dificultades de la población inmigrante en su acceso al SNS, aunque el conocimiento de las normativas es limitado. Una ajustada mayoría respalda la universalidad, existiendo posicionamientos restrictivos con relativa frecuencia, especialmente entre el personal no sanitario. Se reproducen ciertos mitos sobre la atención a población inmigrante, no así acerca del consumo de recursos sanitarios
OBJECTIVES: To report the knowledge and perceptions of Primary Care professionals regarding access to the Spanish National Healthcare System and healthcare assistance provided to the immigrant population, as well as to analyse differences by professional categories. METHODS: A cross-sectional study was conducted by sending a questionnaire to 352 professionals: healthcare workers (HCWs) and non-healthcare workers (non-HCWs) from primary health care centres in the southern region of the Community of Madrid and resident doctors and nurses assigned to this primary healthcare area, from February to March 2019. RESULTS: Overall, 179 professionals (50.9%) replied. Of these, 50.3% thought that migrants face frequent difficulties in access, whereas 65.9% considered that migrants' health is conditioned by their migratory status. Moreover, 80.4% identified language as a relevant barrier and 72.7% of HCWs believed that migrants do not consume more resources. Regarding the Spanish Royal Decree-laws (RDL), 72% admitted having no or little knowledge of Spanish RDL 16/2012, and 66.7% of Spanish RDL 7/2018. However, 30.7% considered that Spanish RDL 16/2012 had negative effects on health, 28.5% agreed that Spanish RDL 7/2018 recovered universal healthcare coverage (UHC). Overall, 54.9% of HCWs support UHC in comparison to 19.1% of non-HCW. CONCLUSIONS: Half the professionals perceive that immigrants encounter frequent difficulties when accessing the Spanish Healthcare System, although their knowledge of legislation is limited. A slight majority supports UHC and finds a large number of restrictive stances, especially among non-HCWs. Certain misconceptions regarding care provided to immigrants persist, but not those related to health resources consumption
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Primary Health Care , Health Personnel , Emigrants and Immigrants/statistics & numerical data , Cross-Sectional Studies , Surveys and Questionnaires , Equity in Access to Health Services , National Health Systems , Social Perception , Health Knowledge, Attitudes, PracticeABSTRACT
Introducción: El objetivo del estudio es describir la evolución de la incidencia de infecciones y colonizaciones por bacterias productoras de carbapenemasas de tipo VIM (BPC-VIM) en pacientes ingresados en un hospital pediátrico de tercer nivel en Madrid entre 2012 y 2015. Material y métodos: Estudio descriptivo de vigilancia epidemiológica. El sistema de vigilancia incluyó detección de casos (cribado de colonización por BPC de todos los pacientes ingresados con periodicidad variable según unidad de ingreso) y medidas de control (precauciones de contacto, identificación al ingreso de pacientes colonizados previamente, limpieza, formación, observación de adherencia a precauciones de contacto, cohortes). Se incluyeron los pacientes ingresados con primera muestra microbiológica positiva para BPC-VIM entre 2012 y 2015. Se realizó seguimiento de pacientes con colonización para detectar infección a través de historia clínica. Resultados: Se detectaron 239 pacientes con colonización y 51 con infección por BPC-VIM (49,3% mujeres, 47,6% edad igual o menor a 5 meses, 52,1% ingresado en UCI). Las incidencias de infección y de colonización fueron, respectivamente, 2,6 y 6,7 casos por mil pacientes ingresados en 2012, 1,8 y 10,0 en 2014 y 0,3 y 5,0 en 2015. El 84,4% compartía unidad con paciente con muestra previa positiva. El 13,0% (31/239) de pacientes colonizados tuvieron infección posterior. Conclusiones: La incidencia de pacientes pediátricos colonizados o infectados por BPC-VIM ha sido variable entre 2012 y 2015, con una clara disminución tras un periodo epidémico. La intensificación de las medidas de vigilancia y control de la transmisión y la coordinación entre los servicios fueron claves en la reducción de casos afectados
Introduction: The aim of this study is to describe the evolution of the incidence of infected and colonized patients with carbapenemase VIM-producing bacteria (CPB-VIM) at a national referral pediatric center in Madrid, Spain, between 2012 and 2015. Material and methods: Descriptive epidemiological surveillance study. The surveillance system included case detection (screening for BPC colonization in all admitted patients, with periodicity according to the ward) and control measures (contact precautions, identification of previously colonized patients at admission, environmental cleaning, education, supervision of contact precautions, and patient cohort). All hospitalized patients with first positive microbiological sample for CPB-VIM in 2012-2015 were included. Colonized patients were followed through clinical history to evaluate later infection. Results: We found 239 colonized and 51 infected patients with CPB-VIM (49.3% women, 47.6% were 5 months old or younger, 52.1% admitted at Intensive Care Unit). Infection and colonization incidence were, respectively, 2.6 and 6.7 cases per one thousand hospitalized patients in 2012, 1.8 and 10.0 in 2014 and 0.3 and 5.0 in 2015. Within these patients, 84.4% shared ward with other patient with previous positive sample. 13.0% (31/239) of colonized patients had a subsequent infection. Conclusions: We have shown data of pediatric patients affected by BPC-VIM, collected from an epidemiological surveillance system that included systematic screening at a national referral center. After an epidemic period, the incidence of cases went down. The surveillance and infection control measures intensification, as well as coordination with involved departments, were key in the handling of the situation
