Características clínicas de reanimações cardiopulmonares intra-hospitalares registradas em prontuário: estudo transversal / Clinical characteristics of in-hospital cardiopulmonary resuscitations recorded in medical records: a cross-sectional study / Características clínicas de las reanimaciones cardiopulmonares intrahospitalarias registradas en las historias clínicas: estudio transversal

Objetivo: identificar características clínicas das paradas cardiopulmonares e reanimações cardiopulmonares ocorridas em ambiente intra-hospitalar. Método: estudo quantitativo, prospectivo e observacional, a partir de informações de prontuários de pacientes submetidos a manobras de reanimação devido à parada cardiopulmonar entre janeiro e dezembro de 2021. Utilizou-se um instrumento baseado nas variáveis do modelo de registro Utstein. Resultados: em 12 meses foram registradas 37 paradas cardiopulmonares. A maioria ocorreu na unidade de terapia intensiva respiratória, com causa clínica mais prevalente hipóxia. 65% dos pacientes foram intubados no atendimento e 57% apresentaram ritmo atividade elétrica sem pulso. A duração da reanimação variou entre menos de cinco a mais de 20 minutos. Como desfecho imediato, 57% sobreviveram. Conclusão: dentre os registros analisados, a maior ocorrência de paradas cardiopulmonares foi na unidade de terapia intensiva respiratória, relacionada à Covid-19. Foram encontrados registros incompletos e ausência de padronização nas condutas.

Objective: identify the clinical characteristics of cardiopulmonary arrests and cardiopulmonary resuscitations in the in-hospital environment. Method: this is a quantitative, prospective and observational study based on information from the medical records of patients who underwent resuscitation maneuvers due to cardiopulmonary arrest between January and December 2021. An instrument based on the variables of the Utstein registration protocol was used. Results: thirty-seven cardiopulmonary arrests were recorded in 12 months. The majority occurred in a respiratory intensive care unit, with hypoxia being the most prevalent clinical cause. Sixty-five percent of the patients were intubated and 57% had pulseless electrical activity. The duration of resuscitation ranged from less than five to more than 20 min. As for the immediate outcome, 57% survived. Conclusion: among the records analyzed, the highest occurrence of cardiopulmonary arrests was in respiratory intensive care units, and they were related to Covid-19. Moreover, incomplete records and a lack of standardization in cardiopulmonary resuscitation procedures were found.

Objetivo: Identificar las características clínicas de paros cardiopulmonares y reanimaciones cardiopulmonares que ocurren en un ambiente hospitalario. Método: estudio cuantitativo, prospectivo y observacional, realizado a partir de información presente en historias clínicas de pacientes sometidos a maniobras de reanimación por paro cardiorrespiratorio entre enero y diciembre de 2021. Se utilizó un instrumento basado en las variables del modelo de registro Utstein. Resultados: en 12 meses se registraron 37 paros cardiopulmonares. La mayoría ocurrió en la unidad de cuidados intensivos respiratorios, la causa clínica más prevalente fue la hipoxia. El 65% de los pacientes fue intubado durante la atención y el 57% presentaba un ritmo de actividad eléctrica sin pulso. La duración de la reanimación varió entre menos de cinco y más de 20 minutos. Como resultado inmediato, el 57% sobrevivió. Conclusión: entre los registros analizados, la mayor cantidad de paros cardiopulmonares se dio en la unidad de cuidados intensivos respiratorios, relacionada con Covid-19. Se encontraron registros incompletos y falta de estandarización en el procedimiento.

Conflictos éticos en un contexto de gestión pública: objeción de conciencia y aborto en la red sanitaria pública española

En este artículo se sostiene, en primer lugar, que (1) la persistencia a nivel internacional de debates éticos en torno al estatus moral del nasciturus y (2) el tradicional compromiso deontológico de los profesionales sanitarios con la salud, tanto de la embarazada como del hijo que espera, dotan de pleno sentido y vigencia al derecho a la objeción de conciencia de dichos profesionales. Sin embargo, donde el aborto legal se configura como prestación sanitaria, surge entonces la dificultad de gestionar esa prestación y, al tiempo, el conflicto moral que expresa la objeción de conciencia. Si en una institución sanitaria pública la objeción es generalizada, se plantea una disyuntiva con implicaciones éticas entre derivar a las gestantes a otras instituciones o aplicar estrategias de integración de personal a nivel de servicio de salud. En el caso de España, se ha aprobado este año una reforma de la Ley Orgánica de salud sexual y reproductiva y de la interrupción voluntaria del embarazo (LOSSRIVE), que manifiesta una voluntad más taxativa de que la objeción de conciencia no impida el acceso al aborto en las instituciones sanitarias públicas, estableciéndose previsiones específicas al efecto. A partir de los trabajos parlamentarios identificamos los principales puntos de discrepancia política que remiten a dispares posiciones de fondo sobre el aborto y afectan al propio planteamiento de la reforma, así como a otros elementos no siempre novedosos -algunos de ellos ya estaban en la LOSSRIVE o se venían aplicando a nivel autonómico con el plácet del Constitucional.

This article argues, first, that (1) the persistence at the international level of ethical debates on the moral status of nasciturus and (2) the traditional ethical commitment of health professionals to the health of both the pregnant woman and the unborn child, give full sense and validity to the right to conscientious objection of these professionals. However, where legal abortion is configured as a health care service, the difficulty of managing this service and, at the same time, the moral conflict expressed by conscientious objection arises. If, in a public health institution, objection is widespread, there is a dilemma with ethical implications between referring pregnant women to other institutions or implementing staff integration strategies at the health service level. In the case of Spain, a reform of the Organic Law on Sexual and Reproductive Health and the Voluntary Interruption of Pregnancy (LOSSRIVE) was approved this year, which shows a more stringent willingness that conscientious objection does not prevent access to abortion in public health institutions, establishing specific provisions to that effect. Based on the parliamentary work, we identified the main points of political discrepancy, which remit to different basic positions on abortion and affect the very approach of the reform, as well as other not always new elements -some of them were already in the LOSSRIVE or were already being applied at the regional level with the approval of the Constitutional Court.

Este artigo argumenta, em primeiro lugar, que (1) a persistência, em nível internacional, de debates éticos sobre o status moral do nascituro e (2) o tradicional compromisso deontológico dos profissionais de saúde com a saúde da gestante e do filho que ela espera, dão pleno sentido e vigência ao direito à objeção de consciência desses profissionais. Entretanto, quando o aborto legal é configurado como um serviço de saúde, surge a dificuldade de gerir esse serviço e, ao mesmo tempo, gerir o conflito moral expresso pela objeção de consciência. Se, em uma instituição de saúde pública, a objeção for generalizada, haverá uma escolha com implicações éticas entre encaminhar as gestantes a outras instituições ou aplicar estratégias de integração de pessoal no nível do serviço de saúde. No caso da Espanha, foi aprovada este ano uma reforma da Lei Orgânica de Saúde Sexual e Reprodutiva e a Interrupção Voluntária da Gravidez (LOSSRIVE) que expressa uma vontade mais constrangedora de garantir que a objeção de consciência não impeça o acesso ao aborto em instituições públicas de saúde, estabelecendo disposições específicas para esse fim. Com base no trabalho parlamentar, identificamos os principais pontos de discrepância política, que remetem a diferentes posições de fundo sobre aborto e afetam a própria aproximação da reforma, assim como outros elementos que nem sempre são novos -alguns deles já estavam no LOSSRIVE ou já estavam sendo aplicados em nível regional com a aprovação do Tribunal Constitucional-.

Desigualdades sociais no diagnóstico do câncer do colo do útero no Brasil: um estudo de base hospitalar / Social inequalities in the diagnosis of cervical cancer in Brazil: a hospital-based study

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

Core data set para la generación de datos de la vida real en esclerosis múltiple: adaptación de una iniciativa global para América Latina / Core data set for real world data in multiple sclerosis: customization for latin america from a global task force recommendation

Introducción: Los objetivos primarios del core data set son reducir la heterogeneidad y promover la armonización entre las fuentes de datos en la esclerosis múltiple (EM), reduciendo así el tiempo necesario para ejecutar esfuerzos en la recolección de datos de vida real. Recientemente, un grupo liderado por la Multiple Sclerosis Data Alliance ha desarrollado un core data set para la recolección de datos del mundo real en EM a nivel global. Nuestro objetivo ha sido adaptar y consensuar este conjunto de datos globales a las necesidades de América Latina para que pueda ser implementado por los registros ya desarrollados y en proceso de desarrollo en la región. Material y métodos. Se conformó un grupo de trabajo regionalmente y se adaptó el core data set creado globalmente (proceso de traducción al español, incorporación de variables regionales y consenso sobre variables que se iban a utilizar). El consenso se obtuvo a través de la metodología Delphi remoto de ronda de cuestionarios y discusión a distancia de las variables del core data set. Resultados: Veinticinco profesionales de América Latina llevaron adelante el proceso de adaptación entre noviembre de 2022 y julio de 2023. Se estableció un acuerdo sobre un core data set de nueve categorías y 45 variables, versión 2023, con la sugerencia de implementarlo en registros desarrollados o en vías de desarrollo y cohortes de EM en la región. Conclusión: El core data set busca armonizar las variables recolectadas por los registros y las cohortes de EM en América Latina con el fin de facilitar dicha recolección y permitir una colaboración entre fuentes. Su implementación facilitará la recolección de datos de vida real y la colaboración en la región.(AU)

Introduction: The primary objective of the core data set is to reduce heterogeneity and promote harmonization among data sources in EM, thereby reducing the time needed to execute real life data collection efforts. Recently, a group led by the Multiple Sclerosis Data Alliance has developed a core data set for collecting real-world data on multiple sclerosis (MS) globally. Our objective was to adapt this global data set to the needs of Latin America, so that it can be implemented by the registries already developed and in the process of development in the region. Material and methods: A working group was formed regionally, the core data set created globally was adapted (translation process into Spanish, incorporation of regional variables and consensus on variables to be used). Consensus was obtained through the remote Delphi methodology of a round of questionnaires and remote discussion of the core data set variables. Results: A total of 25 professionals from Latin America carried out the adaptation process between November 2022 and July 2023. Agreement was established on a core data set of nine categories and 45 variables, version 2023 to suggest its implementation in developed or developing registries, and MS cohorts in the region. Conclusion: The core data set seeks to harmonize the variables collected by registries and cohorts in MS in Latin America in order to facilitate said collection and allow collaboration between sources. Its implementation will facilitate real life data collection and collaboration in the region.(AU)

National record and analysis of pharmaceutical interventions in critical care units: PHARMACRITIC study. / Registro nacional y análisis de intervenciones farmacéuticas en unidades de cuidados críticos: estudio FARMACRITIC.

OBJECTIVE: To design a homogeneous methodology for the registration and analysis of pharmaceutical interventions performed in Spanish critical adults' care units. METHOD: Observational, prospective and multicenter study. In the first stage, a national registry of pharmaceutical interventions will be agreed upon and subsequently all the pharmaceutical interventions performed on adult patients admitted to Spanish CCUs during eight weeks will be recorded. Variables related to the type of CCU, the drug involved in the intervention, type of intervention (indication, effectiveness, safety), recommendation made by the pharmacist and the degree of acceptance will be evaluated. Risk and incidence will be calculated for each of the medication errors detected. The χ2-squared test or Fisher exact test will be used for categorical variables and Mann-Whitney U or Kruskal-Wallis test for continuous variables. All tests will be performed with a significance level α = 0.05 and confidence intervals with confidence 1- α. DISCUSSION: The results obtained from this project will make it possible to obtain a homogeneous classification of the pharmaceutical interventions performed in CCU, a national record and an evaluation of the weak points with the aim of developing strategies for improvement in the pharmaceutical care of the critically ill patient.

[Translated article] Therapeutic management, adherence, and clinical outcomes of heart failure in Andalucía. ANDALIC Protocol.

Heart failure is a prevalent syndrome with high mortality rates, representing a significant economic burden in terms of healthcare. The lack of systematic information about the treatment and adherence of patients with heart failure limits the understanding of these aspects and potentially the improvement of clinical outcomes. OBJECTIVE: To describe the clinical characteristics, therapeutic management, adherence, persistence, and clinical results, as well as the association between these variables, in a cohort of patients with heart failure in Andalusia. DESIGN: This study will be an observational, population-based, retrospective cohort study. Data of patients discharged from an Andalusian hospital with a diagnosis of heart failure between 2014 and 2023 will be extracted from the Andalusian population health database. ANALYSIS: The statistical analysis will incorporate the following strategies: (1) Descriptive analysis of the characteristics of the population cohort, adherence measures, and clinical outcomes. (2) Bivariate analyses to study the association of covariates with adherence, persistence, and clinical results. (3) Multivariate logistic regression and Cox regression analysis including relevant covariates. (4) To evaluate changes over time, multivariate Poisson regression models will be used. By conducting this comprehensive study, we aim to gain valuable insights into the clinical characteristics, treatment management, and adherence of heart failure patients in Andalusia, as well as to identify factors that may influence clinical outcomes. These findings could be critical both for the development of optimised strategies that improve medical care and quality of life of patients and for mitigating the health burden of HF in the region.

Non-traditional sources for health surveillance: using emergency data for early-detection / O uso de fontes não-tradicionais para a vigilância em saúde: atendimentos de urgência para detecção precoce de eventos

Preparation and response to Public Health emergencies involve efforts in developing systems for early detection, alert and response. Models for dealing with notification delay and diversification of data sources are some of the commonly used strategies for faster information and action. In this paper, we present the strategy implemented in Rio de Janeiro municipality, where data from urgency and emergency visits were acquired and modeled, in order to detect trend shifts and generate alerts. From the ICD-10 field in electronic records, time series representing events of interest were created. A GAM model was fitted for smoothing, slope determination in each point, and alert generation. The results obtained are displayed in a dashboard, monitored daily. From 2023, multiple events of interest were identified through the dashboard, some of which lead to coordinated communication and actions in the territory. We draw attention to the potentials in the use of these type of data on identifying events of interest in a timely manner, approaching the concepts of a modern surveillance.

A preparação e resposta às emergências em Saúde Pública envolve o investimento em sistemas de detecção precoce, alerta e resposta. Modelos de correção de atraso de notificação e a diversificação de fontes de dados utilizadas são algumas abordagens comumente utilizadas para geração de informação e ação mais oportunos. Neste artigo é apresentada a estratégia implementada no município do Rio de Janeiro de utilização de dados de atendimentos de urgência e emergência unida à aplicação de modelos de detecção de tendências para geração automatizada de alertas. A partir de CIDs marcados nos prontuários eletrônicos de atendimentos, monitoram-se séries temporais de eventos de interesse no município. Um modelo GAM é ajustado às séries para suavização, determinação da inclinação e geração dos alertas. Os resultados são exibidos em painel e monitorados diariamente. Desde 2023, múltiplos eventos de interesse foram identificados através do painel e resultaram em comunicação coordenada e ações no território. Os resultados exaltam a potencialidade no uso desses dados na identificação de eventos de interesse em tempo oportuno, alinhando-se a conceitos de uma vigilância moderna.

Comparison and combination of three data sources from patient medical records to determine optimal quantification of postoperative morbidity according to the Clavien Dindo Classification and the Comprehensive Complication Index. A prospective study.

INTRODUCTION: It is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC). The objectives of this study were: to analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report. METHODS: Observational and prospective cohort study. The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI). RESULTS: The percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively. The combination of sources improved CCI agreement by 8%-40% in the overall series and 39.1-89.7 % in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35 %-67.5% in operations of greater complexity. The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively. CONCLUSIONS: The combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.

El registro continuado de los efectos adversos mejora los resultados quirúrgicos / Continuous monitoring of adverse effects improves surgical outcomes

Antecedentes: Se ha debatido mucho sobre las ventajas e inconvenientes del uso de bases administrativas o de registros clínicos en los programas de mejora de la atención médica. El objetivo de este estudio ha sido revisar la implementación y los resultados de una política de evaluación continua, mediante un registro mantenido por profesionales de un Servicio de Cirugía. Material y métodos: Se incluyeron, de forma prospectiva, todos los pacientes ingresados en el servicio entre los años 2003 y 2022. Se anotaron todos los efectos adversos (EA) acaecidos durante el ingreso, la estancia en centros de convalecencia o en su domicilio durante un periodo mínimo de 30 días tras el alta. Resultados: De 60.125 registros, en 16.802 (27,9%) se registraron 24.846 EA. Hubo un aumento progresivo del número de EA registrados por ingreso (1,17 en 2003 vs. 1,93 en 2022) con una disminución de 26% de los registros con EA (35% en 2003 hasta 25,8% en 2022), de 57,5% en las reoperaciones (de 8 a 3,4%, respectivamente), y de 80% en la mortalidad (de 1,8 a 1%, respectivamente). Es de remarcar la reducción significativa de los EA graves, observada entre los años 2011 y el 2022 (56 vs. 15,6%). Conclusión: Un registro prospectivo de EA creado y mantenido por profesionales del servicio, junto con la presentación y discusión abierta y trasparente de los resultados, produce una mejora sostenida de los resultados en un servicio quirúrgico de un hospital universitario.(AU)

Background: There has been significant debate about the advantages and disadvantages of using administrative databases or clinical registries in healthcare improvement programs. The aim of this study was to review the implementation and outcomes of an accountability policy through a registry maintained by professionals of the surgical department.Materials and methods: All patients admitted to the department between 2003 and 2022 were prospectively included. All adverse events (AEs) occurring during the admission, convalescent care in facilities, or at home for a minimum period of 30 days after discharge were recorded. Results: Out of 60,125 records, 24,846 AEs were documented in 16,802 cases (27.9%). There was a progressive increase in the number of AEs recorded per admission (1.17 in 2003 vs. 1.93 in 2022) with a 26% decrease in entries with AEs (from 35% in 2003 to 25.8% in 2022), a 57.5% decrease in reoperations (from 8.0% to 3.4%, respectively), and an 80% decrease in mortality (from 1.8% to 1%, respectively). It is noteworthy that a significant reduction in severe AEs was observed between 2011 and 2022 (56% vs. 15.6%). Conclusion: A prospective registry of AEs created and maintained by health professionals, along with transparent presentation and discussion of the results, leads to sustained improvement in outcomes in a surgical department of a university hospital.(AU)

Therapeutic management, adherence, and clinical outcomes of heart failure in Andalucía. ANDALIC Protocol. / Manejo terapéutico, adherencia y resultados clínicos de la insuficiencia cardiaca en Andalucía. Protocolo ANDALIC.

Heart failure is a prevalent syndrome with high mortality rates, representing a significant economic burden in terms of healthcare. The lack of systematic information about the treatment and adherence of patients with heart failure limits the understanding of these aspects and potentially the improvement of clinical outcomes. OBJECTIVE: To describe the clinical characteristics, therapeutic management, adherence, persistence and clinical results, as well as the association between these variables, in a cohort of patients with heart failure in Andalusia. DESIGN: This study will be an observational, population-based, retrospective cohort study. Data of patients discharged from an Andalusian hospital with a diagnosis of heart failure between 2014 and 2023 will be extracted from the Andalusian population health database. ANALYSIS: The statistical analysis will incorporate the following strategies: 1) Descriptive analysis of the characteristics of the population cohort, adherence measures, and clinical outcomes. 2) Bivariate analyses to study the association of covariates with adherence, persistence and clinical results. 3) Multivariate logistic regression and Cox regression analysis including relevant covariates. 4) To evaluate changes over time, multivariate Poisson regression models will be used. By conducting this comprehensive study, we aim to gain valuable insights into the clinical characteristics, treatment management, and adherence of heart failure patients in Andalusia, as well as to identify factors that may influence clinical outcomes. These findings could be critical both for the development of optimized strategies that improve medical care and quality of life of patients and for mitigating the health burden of HF in the region.

Impact of memory bias in the dietary estimation of older adults measured through a food frequency questionnaire and weighed food records: A cross-sectional study in older adults and primary caregivers.

Introduction: Introduction: changes in cognitive performance and memory of older adults (OA) can interfere in their reporting their diet. Objective: to evaluate the impact of memory bias in dietary estimation between OA and their primary caregivers (PC) through the food frequency questionnaire (FFQ) for Mexican OA and weighed food records (WFR). Methods: the present analysis uses the estimated dietary information based on the response provided by 51 older adults (OA) and their primary caregivers (PC) from the validation study of the FFQ for Mexicans OA was conducted during lockdowns for COVID-19. The personnel who applied FFQ and WFR were trained with standardized instruments and procedures. The Wilcoxon test was used to compare the intake per day of the foods and food groups, the Spearman correlation coefficient was used to evaluate the grams of intake per day of the food groups, and kappa coefficient was used to compare the level of food items and food groups between OA and PC. Results: in 11 of 14 food groups, no significant differences were observed between the amounts of intake reported by OA and PC. In the groups of dairy products, fruits, vegetables, and legumes, moderate agreement was observed (κ = 0.63 to 0.79), and in the rest of the groups was strong to perfect (κ ≥ 0.80). Correlation of the amount of intake between OA and PC was high in all food groups (r ≥ 0.87). Conclusion: the high correlation and high agreement between the amounts and frequencies of the food groups consumed as reported by the older adults and primary caregivers indicate that the information from both respondents is reliable.

Introducción: Introducción: los cambios cognitivos y la memoria que presentan los adultos mayores (AM) pueden interferir al momento de reportar los alimentos de su dieta. Objetivo: evaluar el impacto del sesgo de memoria en la estimación de la dieta entre AM y sus cuidadores principales (CP) a través del cuestionario de frecuencia de alimentos (CFA) para AM mexicanos y el registro de peso de alimentos (RPA). Métodos: el presente análisis utiliza la información dietética estimada con base en la respuesta proporcionada por 51 adultos mayores (AM) y sus cuidadores principales (CP) del estudio de validación del CFA para AM mexicanos que se realizó durante el confinamiento por COVID-19. El personal que aplicó CFA y RPA fue capacitado con instrumentos y procedimientos estandarizados. Se utilizó prueba de Wilcoxon para comparar la ingesta por día de los alimentos y grupos de alimentos, el coeficiente de correlación de Spearman para evaluar los gramos de ingesta por día de los grupos de alimentos y el coeficiente kappa para comparar el nivel de alimentos y grupos de alimentos entre AM y CP. Resultados: en 11 de 14 grupos de alimentos no se observaron diferencias significativas entre las cantidades de ingesta reportadas por AM y CP. En los grupos de lácteos, frutas, verduras y legumbres se observó concordancia moderada (κ = 0,63 a 0,79), y en el resto de los grupos fue de fuerte a perfecta (κ ≥ 0,80). La correlación de la cantidad de ingesta entre AM y CP fue alta en todos los grupos de alimentos (r ≥ 0,87). Conclusión: La alta correlación y la alta concordancia entre las cantidades y frecuencias de los grupos de alimentos consumidos según lo informado por los adultos mayores y los cuidadores principales indican que la información de ambos encuestados es confiable.

Equinodermos de la colección biológica del Laboratorio de Ecología Molecular, Microbiología y Taxonomía (LEMITAX) de la Universidad de Guadalajara, México / Echinoderms of the biological collection of the Laboratorio de Ecología Molecular, Microbiología y Taxonomía (LEMITAX) of the Universidad de Guadalajara, Mexico

Resumen Introducción: Las colecciones biológicas representan los cimientos para el conocimiento y manejo de la biodiversidad de una región. No obstante, en México, y en particular en el Pacífico central mexicano (PCM), las colecciones regionales enfocadas en equinodermos, son escasas. La colección biológica del Laboratorio de Ecología Molecular, Microbiología y Taxonomía (LEMITAX) pertenece al Centro Universitario de Ciencias Biológicas y Agropecuarias de la Universidad de Guadalajara, Jalisco, México y sirve como referencia de la biodiversidad marina de la región. Objetivo: Dar a conocer la riqueza de equinodermos resguardada en la colección del LEMITAX. Métodos: Los organismos depositados en LEMITAX se han recolectado mediante buceo libre, SCUBA, y arrastres de fondo con dragas biológicas en diversas áreas del Pacífico mexicano. Los especímenes están preservados en húmedo (alcohol al 70 %; Asteroidea, Echinoidea, Holothuroidea y Ophiuroidea) o en seco (Asteroidea y Echinoidea). Resultados: Los especímenes provienen de los estados de Sinaloa, Nayarit, Jalisco y Colima, incluyendo dos áreas naturales protegidas, el Parque Nacional Isla Isabel y el Santuario de las islas e islotes de Bahía de Chamela. La colección dispone de 20 761 ejemplares de equinodermos distribuidos en 75 especies (10 asteroideos, 17 ofiuroideos, 17 equinoideos y 31 holoturoideos). El estado mejor representado es Jalisco (64 especies) seguido de Nayarit (31), Colima (20) y Sinaloa (11). Bahía de Chamela es la mejor representada (60), seguido de Isla Isabel (22). Se aportan 34 registros nuevos, la mayor contribución es para Bahía de Chamela con 14 registros nuevos, seguido del estado de Jalisco (siete), Nayarit (cuatro), Colima (tres) e Isla Isabel (tres). Para el PCM, se reporta por primera vez la presencia de Astropecten ornatissimus, Luidia phragma, Cucumaria crax y Holothuria (Cystipus) casoae, lo que actualiza su riqueza de equinodermos a 197 especies. Se amplía el intervalo de distribución batimétrica de Ophiactis simplex, Ophiocomella alexandri y Holothuria (Cystipus) casoae, así como el intervalo de distribución geográfica de Cucumaria crax. Conclusiones: Las colecciones biológicas de las universidades contribuyen de manera sustancial al conocimiento de la biodiversidad, como se refleja en la colección LEMITAX, cuya revisión resultó en la actualización de la riqueza de equinodermos de la región.

Abstract Introduction: The biological collections represent the foundation for the knowledge and management of the biodiversity of a region. However, regional collections focused on echinoderms are scarce in Mexico, particularly in the Central Mexican Pacific (CMP). The biological collection of the Laboratorio de Ecología Molecular, Microbiología y Taxonomía (LEMITAX) belongs to the Centro Universitario de Ciencias Biológicas y Agropecuarias of the Universidad de Guadalajara, Jalisco, Mexico and it aims to serve as a reference for the region's marine biodiversity. Objective: To state the richness of echinoderms in the LEMITAX collection. Methods: The organisms deposited at the LEMITAX have been collected by SCUBA, free-diving, and bottom trawls with biological dredges in different areas of the Mexican Pacific. The specimens are wet-preserved (70 % ethanol; Asteroidea, Echinoidea, Holothuroidea, and Ophiuroidea) or dried (Asteroidea and Echinoidea). Results: The specimens are from the states of Sinaloa, Nayarit, Jalisco, and Colima, including two natural protected areas (NPAs), the Isabel Island National Park and the sanctuary of the Islands and Islets of Bahía de Chamela. The collection has 20 761 specimens of echinoderms distributed in 75 species (10 asteroids, 17 ophiuroids, 17 echinoids, and 31 holothuroids). The best-represented state is Jalisco (64 species), followed by Nayarit (31), Colima (20), and Sinaloa (11). Concerning the NPAs, Chamela is the best represented (60), followed by Isabel Island (22). Thirty-four new records are added; the largest contribution is for Chamela, with 14 new records, followed by the state of Jalisco (seven), Nayarit (four), Colima (three), and Isabel Island (three). For the CMP, the presence of Astropecten ornatissimus, Luidia phragma, Cucumaria crax, and Holothuria (Cystipus) casoae, is reported for the first time, updating the echinoderm richness to 197 species. The bathymetric distribution range of Ophiactis simplex, Ophiocomella alexandri, and Holothuria (Cystipus) casoae is extended, as well as the geographic range of Cucumaria crax. Conclusions: The biological collections deposited in the universities contribute substantially to the knowledge of biodiversity, as reflected in the LEMITAX collection, whose revision resulted in the updating of the echinoderm richness in the region.

Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation. / Registro de Melanoma de la Academia Española de Dermatología y Venereología (REGESMEL): descripción y datos en el primer año de funcionamiento.

INTRODUCTION: The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. METHODS: REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. RESULTS: A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. CONCLUSIONS: The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

Detección de violencia machista entre las mujeres atendidas por tentativa autolítica en un servicio de urgencias / Detection of interpersonal partner violence among women treated for attempted suicide in an emergency department

Introducción: Existe evidencia sobre una asociación directa entre la Violencia Machista/Violencia de Género (VdG) y el suicidio, e incluso se señala que la VdG es el principal factor precipitante para que una mujer realice una tentativa suicida. Además, se ha demostrado que las mujeres con enfermedades mentales crónicas sufren especialmente más violencia que la población en general. Sin embargo, existen relativamente pocos datos sobre la capacidad de detección de VdG de los servicios de urgencias. En Catalunya, el Programa Código Riesgo de Suicidio (CRS) atendió a 12.596 persones con episodios de conducta suicida y ha demostrado su eficacia en nuestro hospital. Objetivo principal: Cuantificar el grado de detección de la VdG de nuestros registros sanitarios en mujeres visitadas en el servicio urgencias de nuestro hospital por ideación y/o tentativa suicida y que han sido incluidas en el Programa CRS. Hipótesis principal: La detección actual de VdG en las mujeres es <10%. Metodología: Estudio descriptivo retrospectivo basado en registros electrónicos sanitarios. Se identificaron todas las mujeres que habían estado en seguimiento telefónico en los últimos 12 meses por haber acudido al servicio de urgencias de nuestro Hospital por ideación y/o intento suicida. El período de análisis incluyó del 1 de enero al 31 de diciembre de 2020. Se realizó una revisión completa de todos los informes de alta de estas mujeres visitadas en urgencias y de los registros clínicos de todos los profesionales (médicos, psiquiatrías, enfermeras...) disponibles en la historia clínica informatizada. Se realizó un análisis descriptivo simple de los datos. Resultados: Durante el período de estudio, se detectaron cuatro casos de violencia machista/VdG (1,92%) y dos casos de violencia familiar entre las 208 mujeres que se visitaron por ideación y/o intento autolítico...(AU)

Introduction: There is evidence of a direct association between interpersonal partner/sexist/gender violence (IPV) and suicide, and it is even pointed out that IPV is the main precipitating factor for a woman to make a suicide attempt. In addition, it has been shown that women with chronic mental illness suffer especially more violence than the general population. However, there is relatively little data on the IPV detection capacity of emergency departments. In Catalonia, the Suicide Risk Code Program (CRS) treated 12,596 people with episodes of suicidal behaviour and has demonstrated its effectiveness in our hospital. Main objective: To quantify the degree of detection of IPV in our health records in women visited in the emergency department of our hospital for suicidal ideation and/or attempt and who have been included in the CRS Program.Main hypothesis: Current detection of IPV in women is <10%. Methodology: Retrospective descriptive study based on electronic health records. All the women who had been in telephone follow-up in the last 12 months for having gone to the emergency department of our hospital for suicidal ideation and/or attempt were identified. The analysis period included from January 1 to December 31, 2020. A complete review of all the discharge reports of the women visited in the emergency room and of all the clinical records of all the professionals (doctors, psychiatrists, nurses...) available in the computerized medical record was carried out. A simple descriptive analysis of the data was performed. Results: During the study period, four cases of IPV (1.92%) and two cases of family violence were detected among the 208 women who were visited for suicidal ideation and/or attempt. All the women who were detected with IPV were recommended to visit the Women’s Care Center, but it is unknown if they were actually referred to other professionals or if they actually attended...(AU)

The day-to-day relationship between posttraumatic stress symptoms and social support after sexual assault.

Background: Experiencing sexual assault is associated with a significant increase in risk for developing posttraumatic stress disorder and related concerns (e.g. alcohol misuse). Cross-sectional and longitudinal evidence suggests that social support may be both broadly protective against and eroded by posttraumatic stress symptoms. However, little is known about how different aspects of social support and posttraumatic stress symptoms influence each other in the weeks and months immediately following sexual assault, when posttraumatic stress (PTS) symptoms first emerge.Objective: The present study assessed the day-to-day relationship between social support and PTS in a sample of distressed, alcohol-using, recently-assaulted female survivors participating in a clinical trial of an app-based intervention (N = 41).Method: Participants completed 3 weeks of daily diaries starting within 10 weeks of sexual assault. Mixed-effects models were used to examine prior-day and same-day relationships between PTS and four social support constructs (social contact, emotional support, pleasantness of social interactions, and talking about sexual assault).Results: Results indicate that higher quantity and pleasantness of social interactions over the full sampling period was associated with lower PTS symptoms on any given day. Experiencing better-than-typical social interactions on one day was associated with lower than typical PTS symptoms on that day and the next day. On days when participants discussed their sexual assault with others, they tended to be having higher than usual PTS symptoms.Conclusions: Findings suggest that increasing the quantity and pleasantness of social interactions soon after sexual assault might protect against worsening posttraumatic stress symptoms.Trial registration: ClinicalTrials.gov identifier: NCT03703258.

In N = 41 distressed and alcohol-using female survivors of recent sexual assault, having a higher quantity of social interactions and more pleasant social interactions within 10 weeks of assault was associated with lower posttraumatic stress symptoms.When survivors' social interactions were more pleasant than average on one day, their posttraumatic stress symptoms tended to be lower than average the next day, and recent survivors were more likely to talk about sexual assault on days when their posttraumatic stress symptoms were higher than usual.Interventionists should take note that increasing the quantity and pleasantness of social interactions soon after sexual assault might protect against worsening posttraumatic stress symptoms.

Continuous monitoring of adverse effects improves surgical outcomes.

BACKGROUND: There has been significant debate about the advantages and disadvantages of using administrative databases or clinical registry in healthcare improvement programs. The aim of this study was to review the implementation and outcomes of an accountability policy through a registry maintained by professionals of the surgical department. MATERIALS AND METHODS: All patients admitted to the department between 2003 and 2022 were prospectively included. All adverse events (AEs) occurring during the admission, convalescent care in facilities, or at home for a minimum period of 30 days after discharge were recorded. RESULTS: Out of 60,125 records, 24,846 AEs were documented in 16,802 cases (27.9%). There was a progressive increase in the number of AEs recorded per admission (1.17 in 2003 vs. 1.93 in 2022) with a 26% decrease in entries with AEs (from 35.0% in 2003 to 25.8% in 2022), a 57.5% decrease in reoperations (from 8.0% to 3.4%, respectively), and an 80% decrease in mortality (from 1.8% to 1.0%, respectively). It is noteworthy that a significant reduction in severe AEs was observed between 2011 and 2022 (56% vs. 15.6%). CONCLUSION: A prospective registry of AEs created and maintained by health professionals, along with transparent presentation and discussion of the results, leads to sustained improvement in outcomes in a surgical department of a university hospital.

The importance of data in Pulmonary Arterial Hypertension: from international registries to Machine Learning. / La importancia de los datos en la hipertensión arterial pulmonar: de los registros internacionales al machine learning.

Real-world registries have been critical to building the scientific knowledge of rare diseases, including Pulmonary Arterial Hypertension (PAH). In the past 4 decades, a considerable number of registries on this condition have allowed to improve the pathology and its subgroups definition, to advance in the understanding of its pathophysiology, to elaborate prognostic scales and to check the transferability of the results from clinical trials to clinical practice. However, in a moment where a huge amount of data from multiple sources is available, they are not always taken into account by the registries. For that reason, Machine Learning (ML) offer a unique opportunity to manage all these data and, finally, to obtain tools that may help to get an earlier diagnose, to help to deduce the prognosis and, in the end, to advance in Personalized Medicine. Thus, we present a narrative revision with the aims of, in one hand, summing up the aspects in which data extraction is important in rare diseases -focusing on the knowledge gained from PAH real-world registries- and, on the other hand, describing some of the achievements and the potential use of the ML techniques on PAH.

La precisión de las causas de defunción con intervención judicial en Cataluña en el periodo 2015-2020. Efecto de la declaración a través de la aplicación IML-Web / The accuracy of the causes of death with judicial intervention in Catalonia in the period 2015-2020. Effect of declaration through IML-Web application

Fundamentos: a partir del 1 enero de 2020, los institutos de medicina legal y ciencias forenses (imlcf) empezaron a declarar las causas de muerte directamente al instituto nacional de estadística (ine) mediante una aplicación web (iml-web). El objetivo de este trabajo fue evaluar el impacto de la implementación de esta aplicación en la calidad de los datos recogidos. Métodos: se realizó un estudio descriptivo utilizando datos de las defunciones con intervención judicial ocurridas en cataluña. Se comparó la información del período 2015-2018 y de 2019 con la de 2020. Se calcularon los porcentajes, con intervalo de confianza, de las causas de defunción poco específicas, según diferentes clasificaciones, sobre el total de causas por período y división judicial. Resultados: el porcentaje total de causas de defunción poco específicas se redujo, de forma no significativa, 1,6 puntos entre el período 2015-2018 y el año 2020. El mismo indicador entre el año 2019 y 2020 se redujo 13,4 puntos. El porcentaje de defunciones poco específicas de causas externas mostró reducciones estadísticamente significativas entre ambos períodos. En general los indicadores mostraron diferencias territoriales. Conclusiones: la implementación del iml-web en el año 2020 supone, en comparación con 2019, una mejora en la calidad de la información notificada. En cambio, si se compara con el período 2015-2018, los datos muestran una calidad similar. A nivel general se valora que la información proporcionada por el imlcf de cataluña a través del iml-web es precisa, pero todavía tiene margen de mejora.(AU)

Background: on january first, 2020, the institutes of legal medicine and forensic sciences (imlcf) began to inform the causes of death directly to the national statistics institute (ine) through a web application (iml-web). The objective of this study was to evaluate the impact of the implementation of this application on the quality of the data collected.methods: a descriptive study using deaths data with judicial intervention that occurred in catalonia was carried out. The data of the period 2015-2018 and 2019 was compared with 2020. The percentages, with confidence intervals, of the causes of death that were not specific, according to different classifications, were calculated on the total of cases by period and territory.results: the total percentage of non-specific deaths had decreased, not significantly, by 1.6 points between the period 2015-2018 and 2020. The same indicator between 2019 and 2020 had decreased by 13.4 points. The percentage of non-specific deaths from external causes showed significant drops between both periods and 2020. In general, the indicators displayed territorial differences.conclusions: the roll-out of the iml-web implies, compared to 2019, an improvement in the quality of the data. On the other hand, compared to the period 2015-2018, the data show a similar level of quality. Generally, it is assessed that the information provided by imlcf of catalonia through the iml-web is accurate, but still has room for improvement.(AU)

Epidemiología de la apendicitis aguda en Colombia: Un análisis de las bases de datos administrativas del Ministerio de Salud / Epidemiology of acute appendicitis in Colombia: An Analysis of the Ministry of Health administrative databases

Introducción. La apendicitis aguda es una afección común, con un pico de incidencia entre los 10 y 20 años. La cirugía es el tratamiento preferido y la apendicectomía por laparotomía sigue siendo el estándar, aunque el abordaje laparoscópico ha mostrado menos complicaciones. El objetivo de este artículo fue caracterizar tanto la enfermedad como el tratamiento quirúrgico en Colombia, usando datos de bases oficiales. Métodos. Se accedió a la base de datos del Sistema Integrado de Información para la Protección Social (SISPRO) del Ministerio de Salud de Colombia en febrero de 2023. Se recogieron datos de los pacientes con diagnóstico de apendicitis y con procedimiento de apendicectomía entre 2017 y 2021, y se analizaron por edad, sexo y ubicación geográfica. Resultados. Entre 2017 y 2021 se diagnosticaron 345.618 casos de apendicitis (51,8 % mujeres), con pico de incidencia a los 15-20 años. Se realizaron 248.133 apendicectomías, el 16,7 % por laparoscopia. Los hospitales con más procedimientos reportados estaban en Bogotá, Yopal, Popayán y Florencia. La mortalidad fue de 0,56 % en hombres y 0,51 % en mujeres. Conclusión. La apendicitis es común, con pico a los 10-19 años. Las mujeres tienen mayor probabilidad de apendicectomía, debido a otras afecciones ginecológicas. El acceso a la apendicectomía disminuye la mortalidad; en estos pacientes, el 16 % fue laparoscópica, lo que sugiere que se necesita más entrenamiento y acceso a esta técnica. Este estudio aporta a la comprensión de la epidemiología de la apendicitis y apendicectomías en Colombia.

Introduction. Acute appendicitis is a common condition, with a peak incidence between 10 and 20 years of age. Surgery is the preferred treatment and laparotomy appendectomy remains the standard, although the laparoscopic approach has shown fewer complications. The objective of this article was to characterize both the disease and the surgical treatment in Colombia, using data from official databases. Methods. The Integrated Information System for Social Protection (SISPRO) database of the Ministry of Health was accessed in February 2023. Data with diagnosis of apendicitis and with appendectomy between 2017 and 2021 were collected. Analysis was done by age, gender, and geographic location. Results. Between 2017 and 2021, 345,618 cases of appendicitis were diagnosed (51.8% females), with peak incidence at 15-20 years of age. A total of 248,133 appendectomies were performed, 16.7% by laparoscopy. The hospitals with most reported procedures were located in Bogotá, Yopal, Popayán, and Florencia. Mortality was 0.56% in men and 0.51% in women. Conclusion. Appendicitis is common, peaking at ages 10-19. Women are more likely undergo appendectomy due to other gynecological conditions. Access to appendectomy improves mortality. In these patients, 16% were laparoscopic, suggesting that more training and access to this technique is needed. This study contributes to the understanding of the epidemiology of appendicitis and appendectomies in Colombia.

e-SUS APS: necessidades de melhorias operacionais na percepção dos cirurgiões-dentistas de um distrito sanitário do Recife-PE

Objetivo: Neste estudo, tem-se por objetivo analisar as necessidades de melhorias dos registros, monitoramento e avaliação do e-SUS APS na perspectiva dos cirurgiões-dentistas do Distrito Sanitário I do Recife-PE. Métodos: Trata-se de um estudo com abordagem qualitativa. Os dados foram coletados por meio de entrevistas individuais semiestruturadas, realizadas entre os meses de julho e agosto de 2022, com 8 (oito) cirurgiões-dentistas de equipes de saúde bucal. Para análise dos dados, foi utilizada a técnica de análise de conteúdo. Resultados: Percebe-se que a integração das informações, por meio do software e-SUS APS, facilitou o processo de trabalho dos cirurgiões-dentistas, entretanto, constata-se a necessidade de capacitações dos profissionais de saúde e gestores para o planejamento de atividades com base nas informações produzidas, além do aperfeiçoamento do referido software para incluir especificidades da saúde bucal. Conclusões: O e-SUS APS trouxe melhorias na qualidade e consistência das informações produzidas pelos cirurgiões-dentistas, porém apresenta vários aspectos que necessitam ser melhorados.