Alternativa educativa para la prevención comunitaria de enfermedades de más incidencia en el Adulto Mayor (original)

The Cuban population's aging is a reality that worries to the Cuban State and in that direction it has settled down the Program of Integral Attention to the elderly adults, guided to improving their lifestyles, by means of preventing and treating the illnesses of more incidence. The research provides an educational alternative sustained in physical and natural therapies, to favour the prevention of illnesses of more incidence in the elderly adult from the grandparent circle "Alegría de Vivir" in the municipality of Holguín. As the main results of the educational alternative application, the researchers found that it promotes changes in the lifestyles, habits and customs in the community; it encourages the development of non formal ways of attention to the elderly adult with the creation of programs of self-help; it favours the incorporation of this age bracket to the National Program of Computerization of the Cuban society; it contributes to the realization of creation studies and technological innovation and offers a users manual that instructs the specialists, representatives and elderly adults in its use and generalization.El envejecimiento de la población cubana es una realidad que preocupa al Estado cubano y en esa dirección se ha establecido el Programa de Atención Integral al Adulto Mayor, encaminado al mejoramiento de su estilo de vida, mediante la prevención y el tratamiento de las enfermedades de mayor incidencia. La investigación aporta una alternativa educativa sustentada en terapias físicas y naturales, para favorecer la prevención de las enfermedades de mayor incidencia en el Adulto Mayor del círculo de abuelos “Alegría de Vivir”, del municipio de Holguín. Se utilizan en la investigación métodos a nivel teórico: histórico-lógico, inducción- deducción y análisis- síntesis; a nivel empírico: la entrevista, la encuesta y un taller de socialización; se emplean técnicas de consenso como el grupo nominal y el fórum comunitario. Como principales resultados de la aplicación de la alternativa educativa se encuentran que promueve cambios en los estilos de vida, hábitos y costumbres en la comunidad; fomenta el desarrollo de vías no formales de atención al Adulto Mayor con la creación de programas de autoayuda; favorece la incorporación de este grupo etario al Programa Nacional de Informatización de la Sociedad Cubana; aporta a la realización de estudios de creación e innovación tecnológica y ofrece un manual de usuarios que instruye a los especialistas, representantes y adultos mayores a su uso y generalización

Comportamiento de las infecciones nosocomiales en Unidad de Cuidados Intensivos en un quinquenio (2005 – 2009).

Fundamento: la mortalidad por sepsis de pacientes en estado crítico es frecuentemente alta; cuando un paciente fallece en Unidad de Cuidados Intensivos es más probable que sea a consecuencia de una sepsis que por cualquier otra causa. Objetivo: describir el comportamiento de las infecciones nosocomiales en una Unidad de Cuidados Intensivos. Métodos: estudio retrospectivo, de serie de casos realizado en el Hospital General Universitario Vladimir I. Lenin, de Holguín, que abarca el quinquenio 2005-2009. Se incluyeron 468 pacientes con infecciones nosocomiales diagnosticadas después de 48 horas de su ingreso sin infecciones previas. Los datos fueron obtenidos del libro de registro de infecciones nosocomiales y se determinaron las tasas por año y mes, la localización más frecuente de infección (con una evaluación de las infecciones respiratorias) y los gérmenes más frecuentemente aislados. Se determinó si existía alguna tendencia en las tasas, mediante la prueba de Mann-Kendall para un 95 % de confianza. Resultados: la tasa media de infección fue de 22,5. La media de infecciones fue mayor en los meses cálidos y húmedos de verano (superior al 22 %, p=0,28). La localización más frecuente fue la respiratoria (257/54,9 %) predominando la neumonía asociada a la ventilación mecánica (126/49 %). La tasa media de neumonía por 1 000 días de ventilación fue de 20,3. Los gérmenes más frecuentemente aislados fueron los gramnegativos multirresistentes; predominando el Acinetobacter baumannii (42 aislamientos, 17 en hemocultivos). Conclusiones: predominaron las neumonías asociadas a la ventilación mecánica y la localización respiratoria en las infecciones nosocomiales

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care