Predictive potential of SARS-CoV-2 RNA concentration in wastewater to assess the dynamics of COVID-19 clinical outcomes and infections

Coronavirus disease 2019 - caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) -, has triggered a worldwide pandemic resulting in 665 million infections and over 6.5 million deaths as of December 15, 2022. The development of different epidemiological tools have helped predict new outbreaks and assess the behavior of clinical variables in different health contexts. In this study, we aimed to monitor concentrations of SARS-CoV-2 in wastewater as a tool to predict the progression of clinical variables during Waves 3, 5, and 6 of the pandemic in the Spanish city of Xátiva from September 2020 to March 2022. We estimated SARS-CoV-2 RNA concentrations in 195 wastewater samples using the RT-PCR Diagnostic Panel validated by the Center for Disease Control and Prevention. We also compared the trends of several clinical variables (14-day cumulative incidence, positive cases, hospital cases and stays, critical cases and stays, primary care visits, and deaths) for each study wave against wastewater SARS-CoV-2 RNA concentrations using Pearson's product-moment correlations, a two-sided Mann-Whitney U test, and a cross-correlation analysis. We found strong correlations between SARS-CoV-2 concentrations with 14-day cumulative incidence and positive cases over time. Wastewater RNA concentrations showed strong correlations with these variables one and two weeks in advance. There were significant correlations with hospitalizations and critical care during Wave 3 and Wave 6; cross-correlations were stronger for hospitalization stays one week before during Wave 6. No association between vaccination percentages and wastewater viral concentrations was observed. Our findings support wastewater SARS-CoV-2 concentrations as a potential surveillance tool to anticipate infection and epidemiological data such as 14-day cumulative incidence, hospitalizations, and critical care stays. Public health authorities could use this epidemiological tool on a similar population as an aid for health care decision-making during an epidemic outbreak

Qualitative Analysis by Experts of the Essential Elements of the Nursing Practice Environments Proposed by the TOP10 Questionnaire of Assessment of Environments in Primary Health Care

Background: A short TOP10 scale based on the Practice Environment Scale-Nursing Work Index questionnaire measures the characteristics of nursing work environments. Positive environments result in better quality care and health outcomes. Objective: To identify a small number of core elements that would facilitate more effective interventions by nurse managers, and compare them with the essential elements proposed by the TOP10. Method: Qualitative research by a nominal group of eight experts. The content analysis was combined with descriptive data. Results: Ten most important items were selected and analyzed by the expert group. A high level of consensus in four items (2, 15, 20, 31) and an acceptable consensus in five items was reached (6, 11, 14, 18, 26). The tenth item in the top ten was selected from content analysis (19). The expert group agreed 90% with the elements selected as essential to the TOP10. Conclusion: The expert group achieved a high level of consensus that supports 90% of the essential elements of primary care settings proposed by the TOP10 questionnaire. Organizational changes implemented by managers to improve working environments must be prioritized following our results, so care delivery and health outcomes can be further improved

Predictive potential of SARS-CoV-2 RNA concentration in wastewater to assess the dynamics of COVID-19 clinical outcomes and infections

Coronavirus disease 2019 -caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-, has trig-gered a worldwide pandemic resulting in 665 million infections and over 6.5 million deaths as of December 15, 2022. The development of different epidemiological tools have helped predict new outbreaks and assess the behavior of clinical variables in different health contexts. In this study, we aimed to monitor concentrations of SARS-CoV-2 in wastewater as a tool to predict the progression of clinical variables during Waves 3, 5, and 6 of the pandemic in the Spanish city of Xativa from September 2020 to March 2022. We estimated SARS-CoV-2 RNA concentrations in 195 wastewater samples using the RT-PCR Diagnostic Panel vali-dated by the Center for Disease Control and Prevention. We also compared the trends of several clinical variables (14-day cumulative incidence, positive cases, hospital cases and stays, critical cases and stays, primary care visits, and deaths) for each study wave against wastewater SARS-CoV-2 RNA concentrations using Pearson's product-moment correlations, a two-sided Mann-Whitney U test, and a cross-correlation analysis. We found strong correlations between SARS-CoV-2 concentrations with 14-day cumulative incidence and positive cases over time. Wastewater RNA concentrations showed strong correlations with these variables one and two weeks in advance. There were significant correlations with hospitalizations and critical care during Wave 3 and Wave 6; cross-correlations were stronger for hospitalization stays one week before during Wave 6. No association between vaccination percentages and wastewater viral concentrations was observed. Our findings support wastewater SARS-CoV-2 concentrations as a potential surveillance tool to anticipate infection and epidemiological data such as 14-day cumulative incidence, hospitalizations, and critical care stays. Public health authorities could use this epidemiological tool on a similar population as an aid for health care decision-making during an epidemic outbreakThis research was funded by the Valencian International University and Generalitat Valenciana (GVA) through the Grants to emerging research groups 2023 (CE2023) from the Regional Ministry of Innovation, Universities, Science and Digital Society (CIGE/2022/58).Medicin

Validación transcultural del cuestionario PEQ (Prostesis Evaluation Questionnaire) para amputados vasculares protetizados

Actualmente no hay escalas específicas validadas en español para pacientes protetizados. El propósito de este trabajo es validar al español, un instrumento de fácil administración, específico para pacientes de miembro inferior amputados y protetizados, y que mida la calidad de vida relacionada con el uso de la prótesis. OBJETIVO. Obtener una versión culturalmente equivalente del cuestionario PEQ (Prostesis Evaluation Questionnaire) en español para su uso en pacientes amputados protetizados. MATERIAL Y METODOS. Se trata de un estudio eminentemente descriptivo y exploratorio al ser ésta la primera vez que se prueba el cuestionario PEQ en una muestra representativa en amputados vasculares en nuestro país. El estudio se ha realizado durante el periodo 2006 a 2011 en el departamento de salud Xàtiva- Ontinyent. Siguiendo las recomendaciones de Francis Guillemin para validación transcultural se ha tratado de conseguir un instrumento idiomática y culturalmente equivalente. El cuestionario PEQ tiene nueve dimensiones, con un rango de 0 a 10 puntos: Escala de Apariencia, Escala de utilidad, Escala de Salud del Muñón, Escala de Percepción de la Respuesta, Escala de Bienestar, Escala de frustración, Escala de Carga Social, Escala de Deambulación, Escala de Sonidos. La versión final del cuestionario se administró a un grupo de pacientes seleccionados en base a los siguientes de criterios de inclusión: ser pacientes amputados y protetizados por causa vascular; dar su consentimiento informado para participar en el estudio; tener las facultades cognitivas completas; no tener dificultad visual severa; Disponer de datos administrativos mínimos para tipificar el caso. Los cuestionarios utilizados para la validez de criterio fueron el cuestionario de salud SF-36 y la Escala de Depresión Geriátrica de Yesavage. RESULTADOS. Se reclutaron 61 pacientes, 17 mujeres y 44 hombres, con una edad media de 71,1 años (rango de 51 a 87 años). La patología de base predominante, previa a la amputación, fue la diabetes Mellitus (78%) y el nivel de amputación supracondílea (91,4%). La consistencia interna de los diferentes ítems del cuestionario fue alta (Alfa de Cronbach > 0,50) dentro de cada dimensión salvo para las escalas de Apariencia y Salud del Muñón. Se obtuvo una correlación positiva y significativa del PEQ y el SF 36 en la mayoría de dimensiones y negativa con la escala de depresión de Yesavage. Los pacientes más jóvenes (< 70 años), residentes en poblaciones rurales, laboralmente activos y con un mayor nivel de estudios mostraron unos niveles superiores en diferentes escalas del PEQ. CONCLUSIONES. El cuestionario PEQe es un equivalente cultural con una validez de criterio adecuada para su empleo en la población de pacientes geriátricos españoles protetizados por causa vascular. Los pacientes protetizados vasculares incluidos se caracterizan por un predominio del género masculino, una edad avanzada y un nivel de estudios bajo, lo cual ha podido condicionar la dificultad en la obtención de algunos resultados. El cuestionario PEQe muestra una adecuada consistencia interna en casi todas las dimensiones evaluadas. Aunque en algunas, como Apariencia y Salud del Muñón, es cuestionabl

Sociodemographic Determinants for the Health-Related Quality of Life of Patients with Vascular Amputations as Determined with the Prosthesis Evaluation Questionnaire

Background: To identify the sociodemographic variables independently related to the different dimensions of the Prosthesis Evaluation Questionnaire (PEQ). Methods: An observational, cross-sectional study was conducted, with a sample of 61 Spanish vascular amputees (Valencia, Spain). Included in this study are the results of the PEQ and explanatory-sociodemographic variables, as well as a descriptive and analytic analysis. Results: Gender differences were observed in "appearance" and "perception of appearance" (significantly higher levels for men). Older patients tended to have worse scores in "utility", "frustration", "social burden" and "deambulation". More favorable scores were obtained for those residing in rural areas in "social burden" and "deambulation". Educational level had a positive correlation with scores. Conclusion: Gender, age, place of residence, and educational level could be considered determinants of the quality of health related to prosthesis adaptation in vascular amputees. Clinical relevance: Knowing the influential variables in the process of prosthetization will allow better adaptation and an improvement in the quality of life.Medicin

Spanish Version of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI): A Psychometric Evaluation

Background: The Caregiver Contribution to Self-Care of Heart Failure (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support heart failure (HF) patients to perform self-care. The CC-SCHFI measures caregivers' contribution to self-care maintenance and self-care management and caregiver confidence in contributing to heart failure patients' self-care. To date, the CC-SCHFI has never been tested in Spanish-speaking populations. Purpose: To translate the CC-SCHFI from English into Spanish and to test its psychometric characteristics. Method: CC-SCHFI translation and back-translation were performed according to the Beaton et al. methodology. Data from a cross-sectional study conducted in an outpatient clinic in Spain were used for the analysis. Psychometric analysis was performed with exploratory factor analysis (EFA) with oblique rotation. Results: Caregivers had a mean age of 60.5 years (SD 14,9) and the majority were female (85%). Data from 220 caregivers were analyzed. From EFA, using the principal axis factoring method, we extracted two factors in the self-care maintenance subscale ("treatment adherence behaviors" and "symptom control and maintenance behaviors"), two in the self-care monitoring subscale ("illness behaviors" and "prevention behaviors") and one factor for the self-efficacy subscale. The Pearson's rank correlation coefficients between SCHFI and CCSCHFI showed significant correlation in each subdimension