[Organization and management of nutritional care process in hospitalized patients: the model implemented in the "Hospital Universitario de La Ribera"]. / Organización y funcionamiento de la atención nutricional hospitalaria: el modelo implantado en el Hospital Universitario de La Ribera.

INTRODUCTION: Hospital malnutrition shows a high prevalence and is an indicator of poor quality care. The intervention of different professionals involved in the nutritional care process performing uncoordinated and with different criteria is one of the reasons that contribute to perpetuate this situation. OBJECTIVE: To describe the model implemented in the "Hospital Universitario de la Ribera" for providing nutritional care to patients. METHOD: The model implemented in the "Hospital Universitario de la Ribera" is characterized by the coordinated intervention of the health professionals performing with the common goal of providing patients' nutritional care. The nutrition plan is carried out comprehensively from malnutrition identification to the establishment of the nutrition plan and monitoring as well as its adaptation to the patient's progress and discharge recommendations. The key elements to achieve this goal are described: the Nutrition Department and the Pharmacy Department, the information system available that allows to share and exchange information effectively and a dynamic and interdisciplinary Commission of Nutrition and Dietetics. CONCLUSION: At the "Hospital Universitario de la Ribera" an organization that ensures continuity of care throughout the nutritional process and its connection with primary health care has been established.

Organización y funcionamiento de la atención nutricional hospitalaria; el modelo implantado en el Hospital Universitario de La Ribera / Organization and management of nutritional care process in hospitalized patients; the model implemented in the 'Hospital Universitario de La Ribera'

Introducción: La malnutrición hospitalaria manifiesta una elevada prevalencia y es un indicador de baja calidad asistencial. Entre los motivos que perpetuán esta situación se identifican procesos asistenciales que se realizan por diferentes profesionales con criterios de actuación divergentes y a través de intervenciones fragmentadas. Objetivo: Describir el modelo implantado en el Hospital Universitario de la Ribera para proporcionar atención nutricional. Método: El modelo implementado en el Hospital Universitario de la Ribera tiene como característica diferencial la intervención coordinada de los profesionales que participan en el proceso nutricional con el objetivo de que la atención nutricional se lleve a cabo de forma integral, desde la identificación de la malnutrición, el establecimiento y monitorización del plan nutricional y su adaptación a la evolución del paciente y recomendaciones al alta. Se describen los elementos de estructura para la consecución de este objetivo: el Servicio de Nutrición y Servicio de Farmacia, el sistema de información que permite compartir e intercambiar información de forma efectiva y el funcionamiento resolutivo de la Comisión de Nutrición y Dietética interdisciplinar. Conclusión: En el Hospital Universitario de la Ribera se ha establecido una organización que garantiza la continuidad asistencial a lo largo del proceso nutricional y su conexión con atención primaria de salud (AU)

Introduction: Hospital malnutrition shows a high prevalence and is an indicator of poor quality care. The intervention of different professionals involved in the nutritional care process performing uncoordinated and with different criteria is one of the reasons that contribute to perpetuate this situation. Objective: To describe the model implemented in the ‘Hospital Universitario de la Ribera’ for providing nutritional care to patients. Method: The model implemented in the ‘Hospital Universitario de la Ribera’ is characterized by the coordinated intervention of the health professionals performing with the common goal of providing patients' nutritional care. The nutrition plan is carried out comprehensively from malnutrition identification to the establishment of the nutrition plan and monitoring as well as its adaptation to the patient's progress and discharge recommendations. The key elements to achieve this goal are described: the Nutrition Department and the Pharmacy Department, the information system available that allows to share and exchange information effectively and a dynamic and interdisciplinary Commission of Nutrition and Dietetics. Conclusion: At the ‘Hospital Universitario de la Ribera’ an organization that ensures continuity of care throughout the nutritional process and its connection with primary health care has been established (AU)

Incidencia y factores de riesgo de bronquitis sibilantes en los primeros 6 meses de vida en una cohorte de Alzira (Valencia) / Incidence of wheezing and associated risk factors in the first 6 months of life of a cohort in Valencia (Spain)

Objetivos Determinar la incidencia de bronquitis sibilantes (BS) en los primeros 6 meses de vida en la población de Alzira (Valencia) y analizar los factores de riesgo asociados. Métodos Estudio longitudinal prospectivo basado en una cohorte de 636 niños, incluidos consecutivamente entre marzo de 2007 y noviembre de 2008 tras el nacimiento. Revisión de historias clínicas hospitalarias y ambulatorias a los 6 meses de vida y envío de cuestionarios por correo. Análisis bivariante y multivariante de los distintos factores de riesgo registrados mediante regresión de Cox. Resultados A los 6 meses, el 25,2% de los niños había presentado al menos un episodio de BS, y el 5,6% había presentado 3 o más episodios. El 11,6% de los niños recibió atención en urgencias en alguna ocasión, el 6,6% recibió corticoides orales y el 4% precisó ingreso hospitalario. Se comportaron como factores de riesgo independientes de BS el sexo masculino (riesgo relativo [RR]: 2,1; intervalo de confianza [IC] del 95%: 1,5-2,9), la menor edad gestacional (RR: 1,1; IC del 95%: 1,0-1,2), el nacimiento en el tercer trimestre (RR: 3,5; IC del 95%: 2,0-5,9), el cuarto trimestre (RR: 2,0; IC del 95%: 1,1-3,6) del año, la menor edad materna (RR: 0,9; IC del 95%: 1,0-1,1), la existencia de hermanos mayores (RR: 3,1; IC del 95%: 2,2-4,5), la exposición al tabaco (RR: 1,4; IC del 95%: 1,0-2,0) y el antecedente de asma en la madre (RR: 1,7; IC del 95%: 1,0-3,0); lo hicieron como factores protectores la lactancia materna durante un período igual o superior a 3 meses (RR: 0,6; IC del 95%: 0,4-0,8) y el origen inmigrante de los padres (RR: 0,6, IC del 95%: 0,4- 0,9). Conclusiones La incidencia acumulada de BS en los primeros 6 meses de vida en nuestra población es elevada, y supera la descrita en otros estudios. La mayor parte de los factores de riesgo coinciden con los que señalan otros autores. Destacan como más importantes la existencia de hermanos mayores y el nacimiento en el tercer trimestre del año, lo que refleja el importante papel de las infecciones víricas en la patogenia de las BS a estas edades (AU)

Objectives To determine the incidence of wheezing at 6 months of life in the town of Alzira (Valencia, Spain), and to analyse associated risk factors. Methods We included 636 newborns in a longitudinal birth cohort study between March 2007 and November 2008. Data were collected from hospital and primary care medical records and from questionnaires sent at 6 months post-natal. Bivariate and multivariate Cox regression analysis were performed to examine the risk factors associated with wheezing. Results At 6 months, 25.2% of infants had had 1 or more episodes of wheezing, whereas 5.6% had had 3 or more episodes. Emergency visits were reported in 11.6% of the infants, treatment with oral corticosteroids in 6.6% and admission to hospital in 4%. Independent risk factors for wheezing were male sex (relative risk [RR]: 2.1, 95% confidence interval [95% CI]: 1.5 to 2.9), younger gestational age (RR: 1.1, 95% CI: 1.0 to 1.2), season of birth between July and September (RR: 3.5, 95% CI: 2.0 to 5.9) and between October and December (RR: 2.0, 95% CI: 1.1 to 3.6), younger maternal age (RR: 1.0, 95% CI: 1.0 to 1.1), having siblings (RR: 3.1, 95% CI: 2.2 to 4.5), exposure to smoke (RR: 1.4, 95% CI: 12.0 to 2.0) and history of maternal asthma (RR: 1.7, 95% CI: 1.0 to 3.0). Breast feeding for at least 3 months (RR: 0.6, 95% CI: 0.4 to 0.8) and having immigrant parents (RR: 0.6, 95% CI: 0.4 to 0.9) were protective against wheezing. Conclusion A high cumulative incidence of wheezing in the first 6 months of life was found in our population, in comparison with data reported in other cohort studies. Estimated risk factors were generally in accordance with those described by other authors. Having siblings and season of birth between July and September were the most important risk factors, reflecting the role of viral infections in the pathogenesis of wheezing in early childhood (AU)

[Incidence of wheezing and associated risk factors in the first 6 months of life of a cohort in Valencia (Spain)]. / Incidencia y factores de riesgo de bronquitis sibilantes en los primeros 6 meses de vida en una cohorte de Alzira (Valencia).

OBJECTIVES: To determine the incidence of wheezing at 6 months of life in the town of Alzira (Valencia, Spain), and to analyse associated risk factors. METHODS: We included 636 newborns in a longitudinal birth cohort study between March 2007 and November 2008. Data were collected from hospital and primary care medical records and from questionnaires sent at 6 months post-natal. Bivariate and multivariate Cox regression analysis were performed to examine the risk factors associated with wheezing. RESULTS: At 6 months, 25.2% of infants had had 1 or more episodes of wheezing, whereas 5.6% had had 3 or more episodes. Emergency visits were reported in 11.6% of the infants, treatment with oral corticosteroids in 6.6% and admission to hospital in 4%. Independent risk factors for wheezing were male sex (relative risk [RR]: 2.1, 95% confidence interval [95% CI]: 1.5 to 2.9), younger gestational age (RR: 1.1, 95% CI: 1.0 to 1.2), season of birth between July and September (RR: 3.5, 95% CI: 2.0 to 5.9) and between October and December (RR: 2.0, 95% CI: 1.1 to 3.6), younger maternal age (RR: 1.0, 95% CI: 1.0 to 1.1), having siblings (RR: 3.1, 95% CI: 2.2 to 4.5), exposure to smoke (RR: 1.4, 95% CI: 12.0 to 2.0) and history of maternal asthma (RR: 1.7, 95% CI: 1.0 to 3.0). Breast feeding for at least 3 months (RR: 0.6, 95% CI: 0.4 to 0.8) and having immigrant parents (RR: 0.6, 95% CI: 0.4 to 0.9) were protective against wheezing. CONCLUSION: A high cumulative incidence of wheezing in the first 6 months of life was found in our population, in comparison with data reported in other cohort studies. Estimated risk factors were generally in accordance with those described by other authors. Having siblings and season of birth between July and September were the most important risk factors, reflecting the role of viral infections in the pathogenesis of wheezing in early childhood.

[Estimation of incidence and analysis of sepsis in an area of Valencia (Spain)]. / Incidencia estimada y análisis de la sepsis en un área de Valencia.

OBJECTIVES: To study the incidence of sepsis in an area of Valencia, as well as its characteristics, and to evaluate short-term outcomes. PATIENTS AND METHODS: An active surveillance program was carried out to determine the incidence and characteristics of sepsis. All patients attending the Hospital de La Ribera from January 1999 to December 2004 were included. Incidence rates were calculated and logistic regression analysis was performed. RESULTS: The incidence rate was 60.9 per 100,000 person-years. The incidence was highest among children younger than 1 year (1,138 per 100,000 person-years). A total of 14.4 % of cases were nosocomial infections. The most common microorganisms found were Escherichia coli, Streptococcus pneumoniae and Neisseria meningitidis. Microbiologically undocumented sepsis accounted for 32 % of the cases. The case-fatality rate was 1.3 %. Seventeen patients (11.1 %) were transferred to an intensive care unit (ICU). The risk of being transferred to an ICU was 14 times higher in patients with meningitis than in those with other sources of infection, independently of age and microbiological characteristics (OR 13.9, 95 % CI 2.6-75.3, P = 0.002). CONCLUSIONS: The incidence rate of sepsis is high in the pediatric age group. Clinical sepsis represented an important percentage of pediatric sepsis in our center. The main factor associated with patient transfer to the ICU was the central nervous system as the source of sepsis.

Incidencia estimada y análisis de la sepsis en un área de Valencia / Estimation of incidence and analysis of sepsis in an area of Valencia (Spain)

Objetivos. Estudiar la incidencia de sepsis en un área de Valencia, conocer las características de los casos y evaluar su evolución a corto plazo. Pacientes y métodos. Se desarrolló un programa de vigilancia epidemiológica activo para determinar la incidencia de sepsis y conocer sus características. Se consideró caso todo paciente que acudió al Hospital de La Ribera desde enero de 1999 a diciembre de 2004. Se calculó la densidad de incidencia y se realizó un análisis de regresión logística. Resultados. La densidad de incidencia fue 60,9 por 100.000 persona-años. La mayor incidencia se observó en los menores de un año (1.138 por 100.000 persona-años). El 14,4 % de los casos correspondieron a infecciones nosocomiales. Los microorganismos aislados más frecuentemente fueron Escherichia coli, Streptococcus pneumoniae y Neisseria meningitidis. La sepsis no documentada microbiológicamente correspondió al 32 % de los casos. La letalidad fue del 1,3 %. Se trasladaron a una unidad de cuidados intensivos (UCI) 17 casos (11,1 %). Los casos de meningitis tuvieron 14 veces más probabilidades de ser trasladados a una UCI que los casos cuyo foco de la infección tuvo otra localización, independientemente de la edad y de las características microbiológicas (odds ratio: 13,9; intervalo de confianza del 95 %: 2,6-75,3; p = >0,002). Conclusiones. La sepsis en pediatría tiene una incidencia elevada. La sepsis clínica representó un porcentaje importante de los casos. El principal factor asociado al traslado de los pacientes a la UCI fue la sepsis con origen en el sistema nervioso central

Objectives. To study the incidence of sepsis in an area of Valencia, as well as its characteristics, and to evaluate short-term outcomes. Patients and methods. An active surveillance program was carried out to determine the incidence and characteristics of sepsis. All patients attending the Hospital de La Ribera from January 1999 to December 2004 were included. Incidence rates were calculated and logistic regression analysis was performed. Results. The incidence rate was 60.9 per 100,000 person-years. The incidence was highest among children younger than 1 year (1,138 per 100,000 person-years). A total of 14.4 % of cases were nosocomial infections. The most common microorganisms found were Escherichia coli, Streptococcus pneumoniae and Neisseria meningitidis. Microbiologically undocumented sepsis accounted for 32 % of the cases. The case-fatality rate was 1.3 %. Seventeen patients (11.1 %) were transferred to an intensive care unit (ICU). The risk of being transferred to an ICU was 14 times higher in patients with meningitis than in those with other sources of infection, independently of age and microbiological characteristics (OR 13.9, 95 % CI 2.6-75.3, P = 0.002). Conclusions. The incidence rate of sepsis is high in the pediatric age group. Clinical sepsis represented an important percentage of pediatric sepsis in our center. The main factor associated with patient transfer to the ICU was the central nervous system as the source of sepsis

[Cardiovascular risk factor prevalence among a smoking population starting treatment to quit smoking]. / Prevalencia de factores de riesgo cardiovascular en una población fumadora que inicia tratamiento para dejar de fumar.

BACKGROUND: The prevalence of cardiovascular risk factors in the population at large is high, nevertheless, this rate is known to a lesser degree for a smoking population. The purpose of this study is to ascertain the prevalence of cardiovascular risk factors in a cohort of smokers who are starting treatment to quit smoking. METHODS: This is a descriptive study conducted on a sample of 1887 subjects (1098 males and 789 females) within the 20-80 age range. Each one of these subjects underwent a medical examination, a blood pressure check, total cholesterol, basal gylcemia testing and were measured and weighed. RESULTS: The most prevalent factor was high blood pressure (25%). The prevalence of one or more risk factors related to cigarette smoking was 36.2% (45.3% among males and 23.7% among females, the difference being statistically significant, (chi 2 = 91.4 p < 0.0001). Independently of the number of factors involved, prevalence was always greater among the males. With the exception of bdy mass among males, the prevalence of the rest of the factors showed a significant increase with age among both males and females. Among the males, there was a percentage increase in index related to cigarette smoking. To the contrary, the presence of hypercholesterolemia decreased along with the increase in the amount of smoking. CONCLUSIONS: The prevalence of the cardiovascular risk factors among a smoking population starting treatment is major. This fact conditions the need of setting up measures for taking action to modify these factors.