Estudio de percepción de seguridad en pacientes aislados y no aislados en un hospital de agudos y análisis de concordancia con su identificación por los profesionales / Study of perception of security in isolated and non-isolated patients in an acute hospital and concordance analysis with their identification by the professionals

Objetivo: Evaluar la percepción del paciente sobre la ocurrencia de incidentes relacionados con la seguridad (IRS) y eventosadversos (EA) en pacientes sometidos a precauciones de transmisión (pacientes aislados) y pacientes no aislados durante suingreso hospitalario y compararlo con los identificados por los profesionales sanitarios en la revisión de las historias clínicas en unhospital público universitario de agudos de la provincia de Alicante.Metodología: Estudio transversal mediante encuesta telefónica a pacientes aislados y no aislados con cuestionario validado depercepción de seguridad sobre la ocurrencia de IRS y EA y posterior análisis de concordancia mediante coeficiente Kappa con losidentificados por el personal sanitario en la revisión de historias clínicas.Resultados: Los pacientes aislados respecto a los no aislados, manifestaron haber tenido menos complicaciones médicas poralguna medicación y estas eran poco graves. Por el contrario, manifestaron tener algo más de complicaciones médicas porintervenciones quirúrgicas y ser poco graves. Finalmente, opinaron haber padecido más eventos adversos, respecto a los noaislados. Las diferencias no fueron estadísticamente significativas. En los resultados del índice de concordancia (índice Kappa),de identificación de EA de los pacientes durante su ingreso, y los identificados por los profesionales sanitarios en la revisión de lashistorias clínicas, se observó una fuerza de concordancia leve (Kappa= 0,061).Discusión: Los resultados de nuestro estudio pueden estar influenciados por una escasa información a los pacientes sobre suproceso clínico (diagnóstico, tratamientos y efectos adversos, etc...), esto podría ser la causa del bajo nivel de detección porlos pacientes de los incidentes relacionados con la seguridad que hayan podido suceder durante su ingreso hospitalario...(AU)

Objective: To evaluate the perception of the patient about the occurrences of IRS and AE in patients subjected to transmissionprecautions (isolated patients) and non-isolated patients during their hospital admission and compare it with those identified bythe health professionals in the review of the medical records in a public university hospital for acute care in the province of Alicante.Methodology: Cross-sectional study using a telephone survey in isolated and non-isolated patients with a validated questionnaire in the perception of safety on the occurrence of IRS and AEs and subsequent concordance analysis using the Kappa coefficient withthe identifiers by the health personnel in the review of medical records.Results: The isolated patients compared to the non-isolated ones, stated that they had fewer medical complications due to anymedication and these were not serious. On the contrary, they stated that they had slightly more medical complications fromsurgical interventions and that they were not very serious. Finally, they thought they had suffered more adverse events, comparedto those not isolated. The differences were not statistically significant. In the results of the concordance index (Kappa index), forthe identification of AEs of the patients during their admission, and those identified by the health professionals in the review of themedical records, a slight strength of concordance was discovered (Kappa= 0.061).Discussion: The results of our study may be influenced by insufficient information given to patients about their clinical process(diagnosis, treatments and adverse effects, etc...), this could be the cause of the low level of detection by patients of incidentsrelated to the security that may have happened during their hospital admission...(AU)

Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study).

OBJECTIVES: To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN: A quantitative and qualitative evaluation through a survey and focal groups. SETTING: San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS: The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS: Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS: Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.

Depressive symptoms and psychosocial aspects of work in bank employees.

BACKGROUND: The financial sector has seen an increase in the number of cases of violence and stress, which can result in adverse health outcomes, including depressive symptoms, but studies related to stress at work and depression for these workers are scarce. AIMS: To investigate the association between exposure to psychosocial work stressors and depressive symptoms in bank employees. METHODS: A self-administered questionnaire was completed by a sample of bank employees in Pará and Amapá, Brazil. The survey assessed sociodemographic characteristics, mental health (Patient Health Questionnaire-9), Demand-Control-Support and Effort-Reward Imbalance (ERI). Outcomes included two levels of depressive symptoms: major depressive symptoms (MDS) and other forms of depressive symptoms (ODS). Logistic regression models were used to estimate associations between depressive symptoms, the two job stress models and relevant covariates. RESULTS: Of 2806 eligible subjects, there were 1445 respondents (52% response rate) and the final analyses included 1046 participants. The overall prevalence of depressive symptoms was 32% (MDS = 18%; ODS = 14%), with no statistically significant difference between men and women. High demands, low levels of control and low social support were associated with MDS and/or ODS, adjusted for gender, age and other work-related conditions. High effort/low reward, over-commitment and ERI were also associated with MDS and ODS. CONCLUSIONS: Psychosocial conditions in banking activity involving high strain, low social support at work, high effort with low reward and over-commitment may represent possible risk factors for depressive symptoms in bank employees.

The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used.

We performed a systematic review of the prevalence of metabolically healthy obesity (MHO). Medline, Web of Science and EMBASE were searched for original articles from inception to November 2013. Only prospective and cross-sectional studies were included. After screening 478 titles, we selected 55 publications, of which 27 were population-based studies and were used in the narrative synthesis. From the 27 studies, we identified 30 definitions of metabolic health, mainly based on four criteria: blood pressure, high-density lipoprotein cholesterol, triglycerides and plasma glucose. Body mass index ≥30 kg m(-2) was the main indicator used to define obesity (74% of the studies). Overall, MHO prevalence ranged between 6% and 75%. In the studies that stratified the analysis by sex, prevalence was higher in women (seven out of nine studies) and in younger ages (all four studies). One-third of the studies (n = 9) reported the response rate. Of these, four reported a response rate of ≥70% and they showed MHO prevalence estimates between 10% and 51%. The heterogeneity of MHO prevalence estimates described in this paper strengthens calls for the urgent need for a commonly established metabolic health definition.

Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study.

OBJECTIVE: To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient's features associated with malignancy in a non-high-risk clinical population. METHODS: Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. RESULTS: 25,529 patients were included: 23,102 (90.5%) underwent chest radiograph and 2,497 (9.5%) a CT. The prevalence of SPN was 2.1% (95% CI 1.9 - 2.3) in radiographs and 17.0% (95% CI 15.5 - 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. CONCLUSIONS: The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. KEY POINTS: There is a lower SPN prevalence in the clinical population than in screening studies. SPN prevalence is associated with some patient characteristics: sex, age, imaging test. Nodule characteristics related to malignancy were associated with some patient characteristics.

Waist circumference, BMI and the prevalence of self-reported diabetes among the elderly of the United States and six cities of Latin America and the Caribbean.

Using data from the Salud Bienestar y Envejecimiento (SABE) project and the U.S. National Health and Nutrition Examination Survey (NHANES 1999-2004), we examined the prevalence of obesity and diagnosed diabetes among older adults in the Americas; we also examined the association of age, sex, level of education, weight status, waist circumference, smoking, and race/ethnicity with diabetes among older adults. The prevalence of diagnosed diabetes was highest in the US Blacks and Mexican Americans, followed by Bridgetown and Mexico City (22% for each) and lowest in Santiago, Montevideo, Havana, and US Whites (13-15%). Diagnosed diabetes was significantly associated with BMI among participants from Bridgetown, Sao Paulo, and the three US ethnic groups, while it was associated with waist circumference in all sites except Mexico City. Our findings suggest major geographical and ethnic variation in the prevalence of diagnosed diabetes among older adults. Waist circumference was more consistently associated with the prevalence of diagnosed diabetes than BMI. Higher prevalences of diabetes are found among the elderly of African or Mexican descent in the United States and in other countries of the Americas when compared to the prevalence among whites in the United States and in other Latin American countries with populations of predominant Western European descent.

Antioxidant micronutrients and cataract: a review of epidemiological evidence

La catarata es una de las principales causas de ceguera en la tercera edad y supone un importante problema de salud pública en todo el mundo. La esperanza de vida ha aumentado considerablemente durante este último siglo tanto en países desarrollados como en aquellos en vías de desarrollo. El envejecimiento progresivo de la población probablemente dará lugar a un incremento de las necesidades de recursos para el tratamiento de la catarata. Los estudios epidemiológicos señalan que los alimentos que contienen micronutrientes con capacidad antioxidante podrían proteger frente al proceso de la catarata. Sin embargo, el papel que cada antioxidante desempeñaría en la etiología de la catarata es aún desconocido. Aunque el tratamiento quirúrgico de la catarata es muy eficiente, la altísima incidencia de la catarata en países en vías de desarrollo sobrepasaría la capacidad de cualquier programa de tratamiento. Así pues, una mejor comprensión de la etiología de la catarata podría llevar al desarrollo de estrategias de prevención no quirúrgicas para retrasar o prevenirla. Las estrategias de prevención constituyen el abordaje esencial al problema global de la catarata (AU)

Cataract is one of the leading causes of blindness among the elderly and an important public health problem worldwide. Life expectancy has increased considerably during this century in both developing and developed countries. Population ageing will lead to increased resources required to treat cataract. Epidemiological studies have suggested that intake of foods containing micronutrients with antioxidant potential may be protective against cataract, but the role of the individual antioxidant micronutrients on the cataract process has not been yet elucidated. Although surgical treatment to remove cataract is very effective, the incidence in developing countries is so high that it will overwhelm the capacity of surgical programs. An increased understanding of the aetiology of cataract may lead to the development of non-surgical strategies to delay o prevent cataract. A preventive approach appears to be essential to the global problems of cataract (AU)