Conocimientos adquiridos mediante una intervención educativa grupal en pacientes con tratamiento anticoagulante oral / Knowledge acquired through a group educational intervention in patients on oral anticoagulant therapy

Objetivo: analizar el incremento de conocimientos y el grado de satisfacción obtenidos mediante una intervención educativa para las personas en tratamiento anticoagulante (TAO) seguidas en Atención Primaria. Método: estudio antes-después sin grupo control. La población fueron personas en TAO en seguimiento en el Área de Salud de Gran Canaria (40 centros de salud (CS); N= 11.808). Se estimó una muestra de 250 personas. Se realizó una sesión educativa teórica (40 min) y práctica (60 min) dirigida por una enfermera con grupos de ocho a 16 personas. Se midieron basalmente variables sociodemográficas, clínicas, de tratamiento, conocimientos en anticoagulación medidos con el cuestionario OAK (mín. 0 a máx. 20 puntos) y la satisfacción con la sesión. Se reevaluó el conocimiento a los cuatro meses. Se llevó a cabo estadística descriptiva y bivariante. Resultados: participaron 145 personas de 23 centros de salud (x= 66,9 años; 55,2% hombres). Hubo un aumento del porcentaje de respuestas acertadas y una disminución de las respuestas en blanco en todas las preguntas, siendo estadísticamente significativo el cambio en 16 de ellas (p< 0,05). La media de puntuación del cuestionario OAK aumentó de manera estadísticamente significativa [pretest (= 9,6); postest (=13,8);p= 0,000)]. Un 84,8% de los sujetos había mejorado sus conocimientos tras haber participado en la sesión. El 80% o más encontró muy adecuados distintos aspectos de la sesión. El 91% la recomendaría a otros pacientes. Conclusión: hubo un mayor nivel de conocimientos en anticoagulación a los cuatro meses de la participación en la sesión educativa grupal guiada por una enfermera.(AU)

Objective: to analyse the increase in knowledge and level of satisfaction achieved through an educational intervention for persons on anticoagulant therapy (OAT) followed up at Primary Care. Method: a before-and-after study without control arm. The population was formed by patients on OAT followed up at the Gran Canaria Health Area (40 primary care centres (PCCs); N=11,808). The sample was calculated at 250 persons. A theoretical education session (40 minutes), and a practical session (60 minutes) were led by a nurse with groups from eight to sixteen persons. The following variables were measured at baseline: sociodemographic, clinical, treatment-related, knowledge on anticoagulation measured with the OAK questionnaire (minimum score: 0, maximum score: 20 points), and satisfaction with the session. Knowledge was re-evaluated at four months. Descriptive and bivariate statistics was conducted. Results: the study included 145 persons from 23 PCCs (x= 66.9 years; 55.2% male). There was an increase in the proportion of correct answers and a reduction in blank answers for all questions; the change in 16 of them was statistically significant (p< 0.05). There was a statistically significant increase in the mean score for the OAK questionnaire [pre-test (= 9.6); post-test (=13.8); p= 0.000)]. In total, 845 of the subjects had improved their knowledge after their participation in the session; 80% or more found that different aspects of the session were very adequate, and 91% would recommend it to other patients. Conclusion: there was a higher level of knowledge regarding anticoagulation four months after participating in the group educational session led by a nurse.(AU)

Impacto de la carga de trabajo del paciente crónico en la adherencia terapéutica / Impacto da carga de trabalho crónica do paciente na aderência ao tratamento / Impact of chronic patient treatment burden on adherence to treatment

Aim: To relate the treatment burden of the independent chronic patient to adherence totreatment. Method: Cross-sectional observational analytical study. The sample consisted of 390 patients from the Basic Health Area of Mogán (Gran Canaria) systematically selected according to thecriteria of chronic patient over 50 years of age with established cardiovascular disease includingdiagnoses of Acute Myocardial Infarction, Atrial Fibrillation and Heart Failure (AMI, AF and HF).Chronic Obstructive Pulmonary Disease (COPD) and neurological disease with the diagnoses ofstroke and Parkinson's disease. The Treatment Burden Questionnaire (TBQ) was used to quantifyworkload, and the Morisky Treatment Adherence Scale (MMAS-8) was used for adherence. Results:40.5% of the sample had moderate burden and moderate (38.2%)-low (35.4%) adherence. Low-moderate treatment adherence was associated with a high TBQ score (mean score 64.8 points). The disease groups with the highest burden were neurological diseases (mean TBQ score 74.73 points),COPD (mean TBQ score 69.08 points), and finally cardiovascular diseases (mean TBQ score 64.47points). There is a statistically significant association between workload and adherence x2= 68.343p<0.000. Conclusions: Chronic patients with higher workload present lower therapeutic adherence. (AU)

Objetivo: Relacionar la carga de trabajo del paciente crónico independiente con la adherencia terapéutica. Método: Estudio analítico observacional de tipo transversal. La muestra constade 390 pacientes de la Zona Básica de Salud de Mogán (Gran Canaria), seleccionados de forma sistemática según cumplieran el criterio de paciente crónico mayor de 50 años con enfermedad cardiovascular establecida incluyéndose diagnósticos de Infarto Agudo de Miocardio, Fibrilación Auricular e Insuficiencia cardíaca (IAM, FA e IC). Enfermedad Pulmonar Obstructiva Crónica (EPOC) yenfermedad neurológica con los diagnósticos de ICTUS y Parkinson. Se utilizó el cuestionario“Treatment Burden Questionnarie” (TBQ) para cuantificar la carga de trabajo, y la Escala de Adherencia al Tratamiento de Morisky (MMAS-8) para la adherencia. Resultados: El 40,5% de la muestrapresenta una carga moderada y adherencia moderada (38,2%)-baja (35,4%). La baja-moderada adherencia se asoció con una puntuación elevada del TBQ (puntuación media de 64,8 puntos). Losgrupos de enfermedades que mayor carga tienen son las neurológicas (puntuación media TBQ 74,73puntos), EPOC (puntuación media TBQ de 69,08 puntos), y, por último, las enfermedades cardiovasculares (puntuación media TBQ de 64,47 puntos). Existe una asociación estadísticamente significativa entre la carga de trabajo y la adherencia terapéutica x2= 68,343 p <0,000. Conclusiones: Lospacientes crónicos con mayor carga de trabajo presentan una menor adherencia terapéutica. (AU)

Objectivo: Relacionar a carga de trabalho do paciente crónico independente com a aderência ao tratamento. Método: Estudo analítico observacional transversal. A amostra consistiu em 390pacientes da Área de Saúde Básica de Mogán (Gran Canaria), sistematicamente seleccionados deacordo com os critérios de paciente crónico com mais de 50 anos de idade com doença cardiovascular estabelecida, incluindo diagnósticos de Infarto Agudo do Miocárdio, Fibrilação Atrial e Insuficiência Cardíaca (IAM, FA e IC). Doença Pulmonar Obstrutiva Crónica (DPOC) e doença neurológicacom o diagnóstico de AVC e doença de Parkinson. O Questionário de Carga de Tratamento (TBQ)foi utilizado para quantificar a carga de trabalho, e a Escala de Adesão ao Tratamento Morisky(MMAS-8) foi utilizada para a aderência. Resultados: 40,5% da amostra teve carga moderada e aderência moderada (38,2%)-baixa (35,4%). A adesão ao tratamento com baixa moderação foi associadaa uma pontuação elevada de TBQ (pontuação média de 64,8 pontos). Os grupos de doenças commaior carga são as doenças neurológicas (nota média TBQ de 74,73 pontos), DPOC (nota média TBQde 69,08 pontos), e finalmente as doenças cardiovasculares (nota média TBQ de 64,47 pontos). Existeuma associação estatisticamente significativa entre carga de trabalho e aderência x2= 68.343 p<0.000.Conclusões: Os doentes crónicos com maior carga de trabalho têm menor aderência terapêutica. (AU)

Pulmonary Function and Respiratory Diseases in Different Genotypes of Alpha-1 Antitrypsin Deficiency.

OBJECTIVE: Respiratory disease is the major cause of morbidity and mortality in patients with alpha-1 antitrypsin deficiency, mainly in homozygous PI*ZZ individuals. However, this association is uncertain in subjects with other deficiency genotypes. The objective of this study was to assess, in the context of alpha-1 antitrypsin deficiency, the existence of further risk factors that have been associated with respiratory diseases. MATERIAL AND METHODS: Lung function was assessed by spirometry in a sample of 1334 patients with a known genotype for the SERPINA1 gene whose serum alpha-1 antitrypsin levels had been previously determined. Patients with a normal genotype (PI*MM) were compared to 389 patients carrying a deficiency allele. RESULTS: Statistically significant associations were detected between (i) PI*ZZ genotype and abnormal FEV1 values (χ2 = 26.45; P <.0002), FEV1/FVC (χ2 = 14.8; P < .02) or forced mid-expiratory flow 25%-75% (χ2 =22.66; P < .0009); (ii) chronic obstructive pulmonary disease and PI*ZZ odds ratio: 26.5; 95% CI: (2.6-265.9); P <.005 and or PI*SS genotype odds ratio: 9; 95% CI: (2-40.1); P < .004; (iii) prevalence of COPD in PI*MZ subjects and smoking habit (P < .01), low body weight (P < .01) or older age (P < .0001). CONCLUSION: The PI*ZZ and PI*SS genotypes seem to be associated with the prevalence of chronic obstructive pulmonary disease. Tobacco use, low body weight, and older age are risk factors that increase the probability of prevalence of chronic obstructive pulmonary disease by up to 70% in PI*MZ individuals.

Feelings of being a second victim among Spanish midwives and obstetricians.

AIM: The aim of this study was to determine the prevalence of feelings of being a second victim among midwives and obstetricians in Spain and to explore possible differences between the two professions. DESIGN: Cross-sectional descriptive-analytical observational study. METHODS: An online survey collecting several variables was administered throughout the Spanish territory. Spanish version of the Second Victim Experience and Support Tool (SVEST) was used. The data collection period was from May to December 2020. RESULTS: A total sample of 719 obstetricians and midwives were studied. There were significant differences between the two groups with respect to seven dimensions of SVEST: greater feelings of being a second victim among obstetricians in the dimensions physical distress/p ≤ .001, non-work-related support/p ≤ .001 and absenteeism/p ≤ .001 and greater feelings of being a second victim among midwives in the dimensions psychological distress/p ≤ .001, supervisor support/p = .011, professional self-efficacy/p ≤ .001 and intention to change jobs/p ≤ .001.

Nivel de autocuidados en pie diabético y concordancia de 3 sistemas de estratificación de riesgo en una zona básica de salud de Gran Canaria / Diabetic foot self-care and concordance of 3diabetic foot risk stratification systems in a basic health area of Gran Canaria

Objetivo: Evaluar el nivel de autocuidados en la población con diabetes y determinar el riesgo de padecer lesiones de pie diabético mediante el uso de 3 sistemas de estratificación, así como establecer el grado de concordancia entre estos sistemas. Método: Estudio observacional, transversal y descriptivo realizado en la Zona básica de salud de Santa Brígida (Gran Canaria, Islas Canarias, España) en personas diagnosticadas de diabetes (DM tipo 1/DM tipo 2) (n = 182). Se realizaron entrevista, exploración física, revisión de la historia clínica y cumplimentación del cuestionario Diabetic Foot Self-Care questionnaire of the University of Malaga. Tras ello se calculó la estratificación del riesgo con 3 sistemas (sistema del National Institute for Health Care Excellence, clasificación del International Working Group on the Diabetic Foot y High-Risk Diabetic Foot-60-Second Tool© 2012). Se calculó el índice kappa para estudiar la concordancia entre sistemas, se estimaron el riesgo relativo de screening negativo de un método frente a otro y el test exacto de Fisher para establecer si existían diferencias. Resultados: Un 30,2% de los diabéticos tenían un nivel bajo de autocuidados, un 45,1% un nivel medio y un 24,7% nivel alto. Los niveles de riesgo calculados fueron: fueron clasificación National Institute for Health Care Excellence (riesgo negativo 71,4%; riesgo positivo 28,6%), clasificación del International Working Group on the Diabetic Foot (riesgo negativo 67,0%; riesgo positivo 33,0%) y High-Risk Diabetic Foot-60-Second Tool© (riesgo negativo 62,6%; riesgo positivo 37,4%). Conclusiones: Los 3 sistemas poseen una buena concordancia entre sí. El High-Risk Diabetic Foot-60-Second Tool© solo distingue 2 niveles de riesgo pero detecta mayor porcentaje de personas en situación de riesgo. El cuestionario Diabetic Foot Self-Care questionnaire of the University of Malaga puede ser útil en el contexto de Atención Primaria para evaluar el nivel de autocuidados de las personas con diabetes

Objective: To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3 stratification systems as well as to establish the degree of concordance between these systems. Method: Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n = 182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences. Results: 30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%). Conclusions: All 3 systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2 levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes

Diabetic foot self-care and concordance of 3diabetic foot risk stratification systems in a basic health area of Gran Canaria. / Nivel de autocuidados en pie diabético y concordancia de 3sistemas de estratificación de riesgo en una zona básica de salud de Gran Canaria.

OBJECTIVE: To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3stratification systems as well as to establish the degree of concordance between these systems. METHOD: Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n=182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences. RESULTS: 30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%). CONCLUSIONS: All 3systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes.

Características morfométricas de los órganos genitales de conejas Nueva Zelanda con distintos pesos corporales en el periodo de transición peripuberal / Morphometric characteristics of female reproductive organs of New Zealand rabbits with different body weight in peripuberal period of transition

Morphometric characteristics were determined from female reproductive organs of New Zealand rabbits with different body weight in order to understand the anatomical changes of the various organs of the reproductive tract of this breed in the peripuberal period of transition. Four groups were formed according to a percentage of adult weight (AW), Group A with 2 ± 0.1 kg (40% of AW), Group B with 3 ± 0.1 kg (60% of AW), Group C with 3.5 ± 0.1 kg (70% of AW) and Group D with 4 ± 0.1 kg (80% of AW). The rabbits were euthanized according to the required weight for each group and ovaries, uterine horns, cervix and vagina were removed, in order to measure their length. Ovarian tissue fragments were obtained and processed by paraffin embedding for histological analysis using Masson's trichrome stain. Primordial, primary, secundary and tertiary follicles were counted in the ovarian cortex and medulla. Regarding the length of the left and right ovary there were differences between Group A with respect to B, C and D (P < 0.05). Regarding the length of the uterine horns there were differences between Group A with respect to groups B, C and D in both horns (P < 0.05). Regarding the length of the cervix there was difference between Group B and the others (P < 0.05) and the vagina showed difference between Group A and the other groups (P < 0.05). With respect to the variable number of primordial follicles there was difference between Group A and the other groups (P < 0.05). For primary and secondary follicles there were no differences between the four groups (P > 0.05). In tertiary follicles there were differences between Group A and the others (P < 0.05). Based on the results of this study it is concluded that in New Zealand rabbits the histological and morphometric changes of the reproductive tract associated with body weight, are more dramatic in the transition range from 40% to 60% (groups A and B) of AW, hence, it is a critical period in the maturation of the female reproductive system.

Se determinaron las características morfométricas de los órganos genitales de conejas de la raza Nueva Zelanda con distintos pesos corporales en el periodo de transición peripuberal. Se formaron cuatro grupos de acuerdo con un porcentaje del peso adulto (PA); Grupo A con 2 ± 0.1 kg (40% del PA); Grupo B con 3 ± 0.1 kg (60% del PA); Grupo C con 3.5 ± 0.1 kg (70% del PA) y Grupo D con 4 ± 0.1 kg (80% del PA). A las conejas se les sometió a eutanasia de acuerdo con el peso requerido para cada grupo. Se removieron ambos ovarios, cuernos uterinos, cérvix y vagina con el fin de medir su longitud. Se obtuvieron fragmentos de tejido ovárico que se procesaron por inclusión en parafina para efectuar cortes histológicos que se tiñeron con tricrómica de Masson. Se contaron los folículos primordiales, primarios, secundarios y terciarios presentes en la corteza y médula ovárica. Respecto de la longitud de los ovarios derecho e izquierdo, se encontraron diferencias entre el Grupo A y los grupos B, C y D (P < 0.05). En cuanto a la longitud de los cuernos uterinos, se encontraron diferencias entre el Grupo A y los grupos B, C y D, en ambos cuernos (P < 0.05). En relación con la longitud del cérvix, hubo diferencia entre el Grupo A y los demás grupos (P < 0.05); en la vagina se encontró diferencia entre el Grupo A y el resto de los grupos (P < 0.05). Acerca del número de folículos primordiales, hubo diferencia entre el Grupo A y los otros grupos (P < 0.05). Para los folículos primarios y secundarios no se encontraron diferencias entre los cuatro grupos (P > 0.05). En los folículos terciarios hubo diferencias entre el Grupo A y los demás grupos (P < 0.05). Con base en los resultados obtenidos se concluye que en la coneja Nueva Zelanda los cambios histológicos y morfométricos de los órganos genitales asociados con el peso corporal, son más drásticos en el rango de transición de 40% al 60% (grupos A y B) del PA. Se concluye que se trata de un periodo crítico en el proceso de maduración del aparato reproductor femenino.