Desarrollo y aceptación en el uso de Preanestes@s, una aplicación web para la evaluación preanestésica. Estudio prospectivo de cohortes / Development and patient acceptance of Preanestes@s, a web-based application and electronic questionnaire for preoperative assessment. A prospective cohort study

Antecedentes y objetivos: Preanestes@s es una aplicación para la evaluación preanestésica con un cuestionario electrónico (PreQuest) que facilita la gestión automatizada de la información preoperatoria. Preanestes@s permite la evaluación preoperatoria no presencial-no telefónica. Nuestro principal objetivo fue la identificación de aquellos factores que predicen la compleción adecuada de PreQuest. También evaluamos la experiencia del paciente con la aplicación. Materiales y métodos: Incluimos 880 pacientes adultos programados para cirugía entre los años 2020 y 2021. Evaluamos la influencia de las condiciones del paciente en la compleción de PreQuest y su satisfacción con el uso de la aplicación. Resultados: Un total de 573 participantes (65,1%) completaron PreQuest. La edad menor de 65 años y el mayor nivel educativo se identificaron como predictores independientes para la compleción adecuada de PreQuest (p=0,04 y p=0,001, respectivamente). Un 89,4% de los participantes estuvo de acuerdo en que Preanestes@s era intuitivo y fácil de usar, y más del 85% manifestó su acuerdo con la mejora de la comunicación y la facilidad de uso del prototipo de PreQuest. La versión final de Preanestes@s y PreQuest fue evaluada por 218 participantes, y más del 74% corroboraron su facilidad de uso. Conclusiones: El uso de Preanestes@s para la evaluación preoperatoria está respaldado por altos niveles de satisfacción con el prototipo, y por una tasa de compleción del eQuest superior al 65%. En nuestra muestra, la menor edad y el mayor nivel de educación predijeron una más adecuada compleción de PreQuest. Registrado en Clinical Trials con número NCT04259268.(AU)

Background and objectives: We describe the development of Preanestes@s, a web-based application for preoperative assessment, which incorporates PreQuest, a smart computer-based self-assessment questionnaire for the automated management of information. Preanestes@s potentially enables remote non-telephonic preoperative assessment. The main objective of this work was the identification of factors that independently predict adequate completion of PreQuest. As a secondary objective, we assessed patient experience using the application. Material and methods: To assess the influence of patient conditions on PreQuest completion, our sample included 880 adult patients scheduled to undergo surgery at our institution between February 2020 and February 2021. We evaluated patient satisfaction and acceptability with the use of the application and PreQuest. Results: A total of 573 participants (65.1%) successfully completed the PreQuest. Age below 65 years and higher educational attainment were identified as independent predictors for PreQuest completion (P=.04 and P=.001, respectively). Most (89.4%) participants agreed that Preanestes@s was intuitive and easy to use, with over 85% showing high levels of acceptance of PreQuest prototype's communication improvement and ease of use. The final version of Preanestes@s and PreQuest was evaluated by 218 participants, many of whom (>74%) affirmed its ease of use. Conclusions: The use of Preanestes@s for preoperative assessment is supported by high levels of satisfaction with the prototype and by an eQuest completion rate greater than 65% in a non-selective population. In our sample, younger age and higher education attainment predicted higher rates PreQuest completion. Trial registration number NCT04259268.(AU)

Development and patient acceptance of Preanestes@s, a web-based application and electronic questionnaire for preoperative assessment. A prospective cohort study.

BACKGROUND AND OBJECTIVES: We describe the development of Preanestes@s, a web-based application for preoperative assessment, which incorporates PreQuest, a smart computer-based self-assessment questionnaire for the automated management of information. Preanestes@s potentially enables remote non-telephonic preoperative assessment. The main objective of this work was the identification of factors that independently predict adequate completion of PreQuest. As a secondary objective, we assessed patient experience using the application. MATERIAL AND METHODS: To assess the influence of patient conditions on PreQuest completion, our sample included 880 adult patients scheduled to undergo surgery at our institution between February 2020 and February 2021. We evaluated patient satisfaction and acceptability with the use of the application and PreQuest. RESULTS: A total of 573 participants (65.1%) successfully completed the PreQuest. Age below 65 years and higher educational attainment were identified as independent predictors for PreQuest completion (p = 0.04 and p = 0.001, respectively). Most (89.4%) participants agreed that Preanestes@s was intuitive and easy to use, with over 85% showing high levels of acceptance of PreQuest prototype's communication improvement and ease of use. The final version of Preanestes@s and PreQuest was evaluated by 218 participants, many of whom (>74%) affirmed its ease of use. CONCLUSIONS: The use of Preanestes@s for preoperative assessment is supported by high levels of satisfaction with the prototype and by an eQuest completion rate greater than 65% in a non-selective population. In our sample, younger age and higher education attainment predicted higher rates PreQuest completion. Trial registration number NCT04259268.

Developing active poly(vinyl alcohol)-based membranes with encapsulated antimicrobial enzymes via electrospinning for food packaging.

The present study addresses the immobilization of the GOX enzyme into a conventional polyvinyl alcohol (PVOH) membrane and a multi-layer membrane system (PCL/PVOH/PCL), both synthetized through electrospinning technique. More specifically, the enzyme was encapsulated inside a PVOH hydrophilic membrane, which was in turn protected by two hydrophobic polycaprolactone (PCL) membranes (multilayer system). The manufactured systems were characterized through IR spectroscopy, enzymatic kinetics and mechanical properties. Moreover, the morphology of the fibers composing the membranes was studied by Scanning Electronic Microscopy (SEM) and image analysis. Finally, the enzyme activity of the systems was in-vitro bacterial cultures using E. coli. The results obtained indicate that the addition of the GOX enzyme involves a slight reduction of the mechanical properties (maximum strain at break and maximum stress), which is associated with an increase of the polydispersity of the generated fibers. However, the mats showed antibacterial properties, which were evidenced by the inhibition of E. coli growth. These results indicate that this technique is suitable for the immobilization of enzymes with potential use in the active packaging industry.

Vacunación frente a Neisseria meningitidis / Vaccination against Neisseria meningitidis

La enfermedad meningocócica es causa de morbilidad y mortalidad en todo el mundo, especialmente en niños y adultos jóvenes. Los serogrupos de la Neisseria meningitidis que con más frecuencia producen enfermedad son: A, B, C, W135 y el Y, siendo su distribución diferente según la zona. Las vacunas disponibles producen inmunidad específica frente a los diferentes serogrupos. Todas son seguras y eficaces para los mayores de dos años y se recomiendan en ciertos grupos de riesgo. A pesar de ello, en la actualidad continúa siendo un importante problema de salud pública, ya que, pese a las estrategias interpuestas, la mejora de la inmunogenicidad de las vacunas disponibles sigue constituyendo el reto más importante (AU)

[Prevalence of worker burnout and psychiatric illness in primary care physicians in a health care area in Madrid]. / Prevalencia de desgaste profesional y psicomorbilidad en médicos de atención primaria de un área sanitaria de Madrid.

AIM: To analyze worker burnout and the prevalence of psychiatric illness among primary care physicians, and to determine how burnout is related with sociodemographic and work-related factors. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care centers in Area 8, Madrid (central Spain).Subjects. All 244 physicians (family medicine and pediatrics) who provided care at centers in Area 8 at the time of the study.Method. Anonymous, self-administered questionnaire that included the Maslach Burnout Inventory (worker burnout); GHQ-28 (possible mental illness); survey of sociodemographic and work-related factors, unhealthy behaviors, use of medications, and perceived quality of care and risk of medical errors in relation with work-related pressures; open question regarding causes of work-related stress. RESULTS: Response rate, 80.3%. Burnout was detected in 69.2% of the physicians (95% CI, 62.1%-75.4%) and was severe in 12.3%. The prevalence of possible psychiatric illness was 36.7%. Burnout was found to be related with possible psychiatric illness (P<.01); perception that work-related pressures frequently led to diminished quality of care and medical errors (P<.o1); permanent employment status (P<.05); more than 1700 patients on the patient list (P<.05); age between 37 and 46 years (P<.01) and patient load of 35 to 47 patients/day (P<.05). CONCLUSIONS: The prevalence of worker burnout and possible psychiatric illness was high, and the two variables were related. A large percentage of participants perceived that work-related pressures diminished the quality of care provided.

Prevalencia de desgaste profesional y psicomorbilidad en médicos de atención primaria de un área sanitaria de Madrid / Prevalence of worker burnout and psychiatric illness in primary care physicians in a health care area in Madrid

Objetivo. Analizar el desgaste profesional y la prevalencia de psicomorbilidad entre facultativos de atención primaria (AP) y determinar su relación con aspectos sociodemográficos y laborales. Diseño. Estudio transversal y descriptivo. Emplazamiento. Centros de AP del Área 8 de Madrid. Sujetos. Los 244 médicos y pediatras con labor asistencial en dicha área en el momento de realizarse el estudio. Método. Cuestionario anónimo autoadministrado que incluye: el Maslach Burnout Inventory (mide el desgaste profesional); el GHQ-28 (detección de una posible enfermedad mental); encuesta sobre datos sociodemográficos, laborales, conductas no saludables, consumo de medicamentos y percepción de calidad de la asistencia y riesgo de errores médicos en relación con la presión en el trabajo, y pregunta abierta sobre las causas de estrés laboral. Resultados. La tasa de respuesta fue del 80,3 por ciento. Está afectado por burnout el 69,2 por ciento (IC del 95 por ciento, 62,1-75,4 por ciento) de los facultativos, un 12,3 por ciento de ellos, de forma aguda. La prevalencia de posible psicomorbilidad es del 36,7 por ciento. Se encontró una asociación del desgaste profesional con los siguientes aspectos: una posible psicomorbilidad (p < 0,01); la percepción de que la presión en el trabajo produce con frecuencia una disminución de la calidad y la precipitación de errores médicos (p < 0,01); tener plaza en propiedad (p < 0,05), más de 1.700 pacientes en el cupo (p < 0,05), una edad de 37 y 46 años (p < 0,01) y una presión asistencial de 35-47 pacientes/día (p < 0,05).Conclusiones. Existe una elevada prevalencia de desgaste profesional y de posible psicomorbilidad, apareciendo ambas variables relacionadas. Se percibe en un elevado porcentaje que la presión del trabajo ha hecho disminuir la calidad de la asistencia prestada (AU)

En relación con el burn-out / In relation to the burn-out

No disponible

Diagnostic accuracy and case management of clinical malaria in the primary health services of a rural area in south-eastern Tanzania.

Malaria control continues to rely on the diagnosis and prompt treatment of both suspected and confirmed cases through the health care structures. In south-eastern Tanzania malaria is one of the leading causes of morbidity and mortality. The absence of microscopic examination in most of the health facilities implies that health workers must rely on clinical suspicion to identify the need of treatment for malaria. Of 1558 randomly selected paediatric consultations at peripheral health facilities throughout Kilombero District, 41.1% were diagnosed by the attending health worker as clinical malaria cases and 42.5% prescribed an antimalarial. According to our malaria case definition of fever or history of fever with asexual falciparum parasitaemia of any density, 25.5% of all children attending the health services had malaria. This yielded a sensitivity of 70.4% (IC95% = 65.9-74.8%) and a specificity of 68.9% (IC95% = 66.2-71.5%). Accordingly, 30.4% of confirmed cases left with no antimalarial treatment. Among malaria-diagnosed patients, 10% were underdosed and 10.5% were overdosed. In this area, as in many African rural areas, the low diagnostic accuracy may imply that the burden of malaria cases may be overestimated. Greater emphasis on the functioning and quality of basic health services in rural endemic areas is required if improved case management of malaria is to help roll back this scourge.

Maternal mortality in a rural district of southeastern Tanzania: an application of the sisterhood method.

BACKGROUND: Deaths from maternal causes represent the leading cause of death among women of reproductive age in most developing countries. It is estimated that the highest risk occurs in Africa, with 20% of world births but 40% of the world maternal deaths. The level of maternal mortality is difficult to assess especially in countries without an adequate vital registration system. Indirect techniques are an attractive cost-effective tool to provide estimates of orders of magnitude for maternal mortality. METHOD: The level of maternal mortality estimated by the sisterhood method is presented for a rural district in the Morogoro Region of Southeastern Tanzania and the main causes of maternal death are studied. Information from region-specific data using the sisterhood method is compared to data from other sources. RESULTS: The maternal mortality ratio (MMR) was 448 maternal deaths per 100,000 live births (95%CI : 363-534 deaths per 100,000 live births). Maternal causes accounted for 19% of total mortality in this age group. One in 39 women who survive until reproductive age will die before age 50 due to maternal causes. The main cause of death provided by hospital data was puerperal sepsis (35%) and postpartum haemorrhage (17%); this is compatible with the main causes reported for maternal death in settings with high levels of maternal mortality, and similar to data for other regions in Tanzania. The sisterhood method provides data comparable with others, together with a cost-effective and reliable estimate for the determination of the magnitude of maternal mortality in the rural Kilombero District.