COVID-19 pandemic on coronary artery and cerebrovascular diseases in Southern Spain: interrupted time series analysis.

OBJECTIVE: Healthcare systems have been put under intense pressure by the COVID-19 pandemic, although some studies have shown a decline in hospital admissions for cardiovascular and cerebrovascular diseases during the first and second wave of the pandemic. In addition, studies analyzing gender and procedural differences are scarce. The present study aimed to determine the impact of the pandemic on hospital admissions for acute myocardial infarction (AMI) and cerebrovascular disease (CVD) in Andalusia (Spain) and analyzed differences by gender and by percutaneous coronary interventions performed. PATIENTS AND METHODS: An interrupted time series analysis of AMI and CVD hospital admissions in Andalusia (Spain) was carried out to measure the impact of the COVID-19 outbreak. AMI and CVD cases admitted daily in public hospitals of Andalusia between January 2018 and December 2020 were included. RESULTS: During the pandemic, significant reductions in AMI [-19%; 95% confidence interval (CI): (-29%, -9%), p<0.001] and CVD [-17%; 95% CI: (-26%, -9%); p<0.01] in daily hospital admissions were observed. Differences were also produced according to the diagnosis (ST-Elevation Myocardial Infarction, Non-ST-Elevation Myocardial Infarction, other AMI and stroke), with a greater reduction in females for AMI and in males for CVD. Although there were more percutaneous coronary interventions during the pandemic, no significant reductions were observed. CONCLUSIONS: A decline in AMI and CVD daily hospital admissions during the first and second wave of COVID-19 pandemic was noted. Gender differences were observed, but no clear impact was observed in percutaneous interventions.

Vaginal birth after caesarean section before and during COVID-19 pandemic. Factors associated with successful vaginal birth.

BACKGROUND: The ratio of caesarean has been increasing considerably in many countries. Planning a vaginal birth after a previous caesarean is considered an important option for women in a subsequent pregnancy. AIMS: To analyse obstetric and neonatal outcomes in women in labour after caesarean section before and during the COVID-19 pandemic, and to determine factors associated with successful vaginal birth after caesarean (VBAC). METHODS: Observational cohort study of women in labour with history of caesarean section who gave birth between March 2019 and December 2020 in a tertiary hospital in southern Spain. Consecutive sampling was performed using the maternal birth database and a descriptive and inferential analysis of the study variables was carried out. Socio-demographic, obstetric and neonatal variables were compared between the pre-pandemic and pandemic periods. Multiple logistic regression analysis was performed to determine variables associated with VBAC success. FINDINGS: The VBAC success rate was 67.4%. The caesarean section rate was significantly higher during the COVID-19 pandemic period. Factors associated with VBAC success were: birth before the pandemic (OR 0.32) and at night (OR 0.45), use of epidural analgesia (OR 2.14), and having had a previous vaginal birth (OR 1.98). CONCLUSIONS: The success rate of VBAC was lower during the pandemic. Knowledge of the factors related to VBAC success is critical for practitioners when supporting women in decision-making about mode of birth after a previous caesarean section.

Ventilatory therapies and Intensive Care admissions for patients with COVID-19: a systematic review.

OBJECTIVE: The aim of the study was to synthesize and analyze the scientific publications related to ventilatory therapies used in patients with COVID-19 in Intensive Care Units (ICUs), the parameters of invasive mechanical ventilation prescribed for these patients, and the clinical characteristics of patients admitted to the ICU. MATERIALS AND METHODS: A systematic review was carried out through the PubMed, Embase, Web of Science and Cochrane Library databases. Studies published up to 31/05/2020 were included if they made reference to ventilatory therapies used in ICU patients with COVID-19. RESULTS: Qualitative analysis was performed on 30 included studies. A total sample of 48,743 patients was analyzed, of which 17.66% were admitted to ICUs, and 6.4% of these patients died. Of the patients analyzed, 44.4% required some type of respiratory support. Specifically, 12.8% of patients received invasive mechanical ventilation, while 9.7% received non-invasive mechanical ventilation, and 29.7% received high-flow nasal oxygen. CONCLUSIONS: COVID-19 has led to a high number of ICU admissions and a challenge for ICUs is to provide the best ventilatory therapy available to patients admitted. It has been observed that the available figures for ICU admissions and the use of ventilatory therapies are similar across continents. However, the data suggest that geographic areas with higher rates of ICU admission have lower mortality rates. The lack of information in some of the clinical records limits the ability to obtain more conclusive results.

Mortality and critical conditions in COVID-19 patients at private hospitals: weekend effect?

OBJECTIVE: The aim of the study was to find factors associated with the mortality of admission to the intensive care unit (ICU) in patients with COVID-19. MATERIALS AND METHODS: Retrospective observational study with a database of 1987 patients with COVID-19 who had attended the emergency department of a private hospital network between February 2020 and April 2020 were analyzed. Clinical variables and some laboratory parameters were studied. The Charlson and Elixhauser comorbidity indices were calculated. The dependent variables were mortality and admission to the ICU. A descriptive and correlational analysis was performed. Logistic regression models and Kaplan-Meier survival curves were established. RESULTS: Positive correlations were observed between age, creatinine, and D-dimer levels, as well as with the scores obtained with the Charlson and Elixhauser indices. Differences in the levels of these parameters were also observed when analyzing variables such as mortality, sex or admission to the ICU. Mortality was associated with high creatinine and D-dimer levels and advanced age. Survival curves indicated longer survival in patients not admitted to the ICU, admitted to the hospital during the week, and in those with lower creatinine and D-dimer levels. CONCLUSIONS: Mortality in Spanish patients with COVID-19 admitted to private hospitals was associated with high creatinine and D-dimer levels and advanced age. Longer survival was obtained on weekdays. This study provides valuable information on the management and nursing care of these patients in order to optimize resources in pandemic situations.

Sleep, dreams, nightmares, and sex-related differences: a narrative review.

OBJECTIVE: The aim of this study was to review the available findings on sex-related differences for sleep disorders, dreams and nightmares. MATERIALS AND METHODS: We explored the PubMed, EMBASE and Google Scholar electronic databases, with regards to the searching terms 'sleep', 'dreams', and 'nightmares' associated with 'sex' and/or 'gender'. Moreover, other supplementary terms for the searching strategy were 'chronobiology', and 'circadian rhythm'. Due to the relative paucity of studies including separate analysis by sex, and especially to their wide heterogeneity, we decided to proceed with a narrative review, highlighting the sex-related findings of each topic into apposite boxes. RESULTS: On one hand, sleep disorders seem to be more frequent in women. On the other hand, sex-related differences exist for either dreams or nightmares. As for the former, differences make reference to dream content (men: physical aggression, women family themes), self-reported perspective (men dream in third person, women in first person), dream sharing (more frequent in women), lucid dreaming (women more realistic, men more controlled), and daydreaming (young men more frequently have sexual themes). Nightmares are more frequent in women too, and they are often associated with sleep disorders and even with psychiatric disorders, such as depression and/or anxiety. In women, a strong association has been shown between nightmares and evening circadian preference. CONCLUSIONS: For many years, and for many reasons, laboratory experiments have been conducted mainly, if not exclusively, on male animals. Thus, a novel effort towards a new governance of scientific and research activities with a gender-specific perspective has been claimed for all areas of medicine, and more research on sex-differences is strongly needed also on this topic.

Twenty-four-hour, weekly and annual patterns in serious falls of non-institutionalized independent Spanish seniors.

OBJECTIVE: The study aimed to explore clock hour, day-of-week, and month-of-year patterns of serious falls experienced by non-institutionalized Spanish seniors (age ≥65 years) in relation to associated conventional intrinsic and extrinsic factors. PATIENTS AND METHODS: Intake emergency department records from January 1 to December 31, 2013 of a tertiary hospital of southern Spain were abstracted for particulars of falls, including the time of occurrence, experienced specifically by non-institutionalized seniors. Chi-squares and Single and Multiple-Component Cosinor (time series) Analyses were applied to determine the statistical significance of observed 24-hour, 7-day, and annual variation. RESULTS: Falls were ~2.5-fold more numerous in older women than older men and ~7-fold more frequent between 12:00 and 14:00 hours than ~02:00 hours, respectively, the time spans corresponding to the absolute peak and trough of the 24-hour pattern in falls. The midday/early afternoon peak primarily represented incidents of women ≥75 years of age that occurred inside the home while walking, standing, or moving on stairs. A late evening less prominent excess of mostly inside-the-home incidents of women ≥75 years of age, largely due to fragility, slipping, stumbling, or tripping, was additionally detected. Cosinor Analysis substantiates statistical significance of the 24-hour patterning of falls of men and women (both p<0.001). Day-of-week differences, with prominent Thursday peak and Sunday minimum, were additionally detected, but only for falls of women occurring outside the home (Cosinor Analysis: p=0.007). Day-of-week discrepancy in female/male sex ratio (SR) of fallers was demonstrated, arising from day-of-week disparity in the SR of inside-the-home incidents, with ~4.5-fold more elderly women than elderly men falling Thursday than any other day of the week (p=0.005). Non-statistically significant month-of-year difference in falls, lowest in autumn and highest (~60% more) in winter, was observed and explained by prominent seasonal difference in incidents by elderly women. CONCLUSIONS: Serious falls of non-institutionalized independent seniors are characterized according to intrinsic and extrinsic factors by prominent 24-hour and 7-day patterning. These findings complement the understanding of the epidemiology of falls of the elderly and further inform fall prevention programs.

Sociodemographic factors associated with preterm birth and low birth weight: A cross-sectional study.

BACKGROUND: Preterm birth and low birth weight are two public health problems worldwide associated with higher morbidity and perinatal death risk. AIMS: To determine the incidence and socio-demographic factors associated with preterm birth and low birth weight in Spanish women. METHODS: Cross-sectional study with data from women who gave birth in Spain during 2015 extracted from the Statistical Bulletin of births (National Institute Statistics). Records analysed were 331,449. Single births from 22 weeks gestation and fetuses with weight ≥ 500 g were included. Unadjusted and adjusted odd ratios with 95% confidence interval in a multiple logistic regression model were calculated. Variables associated with both health problems were considered dependent variables. FINDINGS: Preterm birth rate in Spain was 6.7% and low birth weight rate was 7.3%. Socio-demographic variables associated with preterm birth were maternal age ≤19 years, immigrant mothers, educational level ≤ secondary studies, and women living in large cities. Low birth weight was related to maternal age ≤19 years and ≥35 years, educational level ≤ secondary studies, and single mothers. Not having previous children and caesarean births were associated with both risks. CONCLUSIONS: The rates of both risks decreased in Spain, one of the countries in Europe where maternal age at having the first child has increased the most and with the lowest birth rate in the world. Maternal age, educational level, maternal nationality, marital status and population size were associated with one or both risks, so the results of this study could be especially relevant to the clinical practice.

Social support for elderly people over 65 years in Spain.

AIMS: To determine what social support is available in Spain to people over 65 who also dedicate hours of their time to the care of others who are older. BACKGROUND: Demographic and social changes are leading to growth of the population. The social support available to older people in the final stage of life affects their health. METHODS: A cross-sectional study was conducted involving the records of older, non-institutionalized individuals residing in Spain, obtained from the European Health Survey of 2014. The method of collecting information used in the European Survey was personal interviews assisted by a computer. RESULTS: The records of 6520 older people were studied; 40.1% of the participants studied had expressed the possibility of having three to five people available in case of a serious problem, and 83.6% reported that the rest of the people around them were very interested in what happens to them. With respect to care, only 7% of the older people studied mentioned performing care tasks. CONCLUSIONS: Social support is beneficial to older people, regardless of whether they perform care tasks, because it acts as a protective factor against problems such as loneliness, stress and depression. The profile of a primary caregiver in this age range is a married, middle-class woman with primary schooling who is caring for a first-degree relative. IMPLICATIONS FOR NURSING AND HEALTH POLICY: These data suggest that it is necessary for nurses to know about the needs of older people to implement societal measures of health promotion, prevention and education that favour social cohort. In addition, health policymakers should establish programmes that improve the social support of non-institutionalized older people.

Violence committed by intimate partners of physicians, nurses and nursing assistants.

AIM: To estimate the prevalence of intimate partner abuse in physicians, nurses and nursing assistants and risk factors in the Spanish Health Service. BACKGROUND: In Spain, the national public health service is the most likely point of primary care access for victims of intimate partner violence. However, health professionals are also victims of violence by their intimate partner. Little research has been undertaken exploring the prevalence and risk factors of this abuse in health professionals. METHODS: A cross-sectional multicenter study in professionals of both sexes who were working in the Spanish Public Health Service was performed. The health professionals completed an online survey of intimate violence abuse: for women, the screening of abuse against women by an intimate partner, and for men, the domestic violence screening tool in a family setting. A descriptive and comparative analysis was performed. RESULTS: The sample consisted of 1071 professionals: 49.9% were physicians, 46.9% were nurses and 3.3% were nursing assistants. Of the participants, 26.6% had experienced some form of abuse, and 73.3% of the abused professionals had not spoken of their experience of abuse with anyone else. CONCLUSION: Men experienced a lower incidence of intimate partner violence than women. In fact, 34% of the female participants were in an abusive relationship, which is a higher percentage than that observed in studies of the general Spanish female population (11.7%). It appears that being female and a nurse are risk factors for abuse. IMPLICATIONS FOR NURSING AND HEALTH POLICY: These data suggest the urgent implementation of action plans for the provision of support for the victims and for interventions aimed at reducing the problem. Better training and awareness-raising programmes that improve the detection of intimate partner violence and the care of its victims are also necessary.

Falls Suffered by Elderly People From the Perspective of Health Care Personnel: A Qualitative Study.

An exploratory interpretative study was carried out to recognize the factors regarded by health care professionals as potential obstacles to the evaluation, prevention, and documentation of falls in persons above 65 years of age. Focus groups and questionnaires were carried out. Audio recordings were made, and these were subsequently transcribed and analyzed in accordance with the Bardin's thematic content analysis. Four focus groups of four persons were set up, and 16 questionnaires were returned. Four thematic categories were obtained. The analysis showed a lack of data in records of falls, perhaps for reasons of overwork, lack of motivation, awareness, or consistency in the registration systems in use. Health care professionals document two types of fall, depending on the elderly person's ability to carry out everyday tasks. There is not a rigorous and systematic approach for recording falls. Perspectives from health care professionals could help in analyzing the causes of falls and suggesting comprehensive preventive measures.