Problemas de salud y factores determinantes del número de visitas a demanda en pacientes hiperutilizadores de un centro de salud

ObjetivosDescribir las características sociodemográficas y problemas de salud que presentan los pacientes hiperconsultadores de un centro de salud y determinar los factores que explican el número de visitas solicitadas en consulta demanda del médico de familia.DiseñoDescriptivo, retrospectivo. Análisis multivariante: regresión lineal múltiple.EmplazamientoCentro de salud urbano.PacientesPacientes que han solicitado cita para consulta demanda en el centro de salud en al menos nueve ocasiones durante 1999 (n = 7.852). Muestra aleatoria de 386 pacientes (alfa, 0,05; precisión, 95%).Mediciones y resultados principalesVariable dependiente: número de consultas demanda solicitadas en 1999. Variables independientes: edad, tamaño familiar, zona residencia, activo o pensionista, inclusión en programas, problemas de salud (CIAP-2), número de fármacos en prescripción repetida (clasificación anatómica), incapacidad laboral temporal (IT). Los hiperconsultadores son un 57,8% (IC, 52,9-62,7%) mujeres; edad media, 55 años (DE, 18,5); tamaño familiar, 2,7 miembros (DE, 1,457); 58,8% pensionistas; número medio de citas, 15 (DE, 6,7); consumo medio, 1,58 (DE, 2,46) fármacos de forma habitual; inclusión en programas: 37,7%, hipertensión; 16%, diabetes; 17%, dislipemia; 16%, consulta de enfermería. Patologías más prevalentes: cardiocirculatorias (43,8%), endocrinometabólicas (32%), traumatológicas (26,7%) y salud mental (21%). El modelo de regresión incluye las variables edad, número de fármacos y haber estado en IT.ConclusionesLos hiperconsultadores de nuestro centro de salud son mujeres de edad media con problemas de salud física de evolución crónica y problemas de salud mental. El número de visitas está relacionado con la edad y las necesidades administrativas: medicación y bajas.ObjectivesTo describe the social and demographic characteristics and health problems of over-users of a health centre and to determine the number of attendances requested on demand at the general medical clinic.DesignRetrospective and descriptive. Multivariate analysis: multiple linear regression.SettingUrban health centre.PatientsPatients who requested a consultation at the health centre on at least nine occasions in 1999 (N = 7852). Random sample of 386 patients (alpha 0.05, 95% accuracy).Measurements and main resultsDependent variable: number of on-demand consultations requested in 1999. Independent variables: age, family size, area of residence, active or pensioner, inclusion in programmes, health problems (CIAP-2), number of drugs on repeat prescription (Anatomical Classification), short-term time off work. 57% of over-users were women (CI, 52.9-62.7%); mean age 55 (SD 18.5); family size 2.7 members (SD 1.457); 58.8% pensioners. Mean number of appointments 15 (SD 6.7). Mean habitual consumption of 1.58 medicines (SD 2.46). Inclusion in programmes: 37.7% hypertension, 16% diabetes, 17% dyslipaemia, 16% nursing clinic. Most prevalent pathologies: cardiocirculatory (43.8%), endocrino-metabolic (32%), traumatology (26.7%) and mental health (21%). The regression model included the variables of age, number of medicines and having had short-term time off.ConclusionsOver-users of our health centre are middle-aged women with chronic physical health problems and with mental health problems. The number of attendances is related to age and administrative requirements: medication and sick notes

Did COVID-19 policies have the same effect on covid-19 incidence among women and men? Evidence from Spain and Switzerland

Objective: This study aimed to investigate how COVID-19 prevention policies influenced the COVID-19 incidence in men and women. Methods: We conducted a retrospective longitudinal study using the Swiss Federal Office of Public Health and the Spanish Ministry of Health surveillance data for February 2020-June 2021 to explore sex and age differences in COVID-19 cases and testing. The female-male incidence rate ratios (IRR) were estimated for each week of the pandemic. We complemented our analysis with qualitative information on relevant containment measures in each country. Results: In Switzerland and in Spain, there was an excess of cases in women of 20-59 years old and 80+. This excess of cases was significant during the waves of the pandemic in both countries. In Switzerland, the biggest difference was observed for the age group 20-29, reaching an excess of 94% of cases compared to men during the first wave of COVID-19 (March-May 2020). The excess of cases in women was greater in Spain than in Switzerland, where it reached 159% for women aged 20-29 during the first wave (March-June 2020). In both countries, the age groups 60-79 had a significant excess of cases in men during the pandemic. Conclusion: COVID-19 public health policies affect men and women in different ways. Our findings highlight the importance of gender-sensitive responses to address a public health crisis

La disfunción familiar como predisponente de la enfermedad mental. ¿Existe tal asociación?

ObjetivosEl objetivo principal es conocer la relación entre la disfunción familiar y la presencia de trastorno mental. El objetivo secundario es conocer la prevalencia y la distribución de los principales tipos de patología mental en la población atendida en atención primaria.Diseño y emplazamientoEstudio descriptivo y transversal realizado en 6 consultas de medicina de familia de un área básica de salud semiurbana.MétodoSe seleccionaron 280 sujetos mediante muestreo aleatorio sistemático de los que acudieron espontáneamente a la consulta. Mediante entrevista se recogieron las variables de estudio: dinámica familiar (medida mediante el test de APGAR familiar), estructura familiar, variables sociodemográficas y presencia de trastorno mental detectado mediante la Mini International Neuropsyquiatric Interview (MINI-DSM IV).ResultadosAceptaron participar 264 sujetos. Un 64,4% era mujer y la media de edad fue de 45,6 años (DE, 16,7). Se detectó patología mental en 87 participantes (33%), siendo la patología más frecuente trastorno de ansiedad generalizada, distimia y depresión mayor. Se encontró alteración de la dinámica familiar en 32 personas (12,3%). No se observaron diferencias significativas en la frecuencia de presentación de patología mental entre el grupo con disfunción familiar y el resto.ConclusionesLos trastornos de salud mental son frecuentes entre los pacientes que acuden a las consultas de atención primaria. No encontramos asociación entre las alteraciones de la dinámica familiar y los trastornos de salud mental, lo que podría deberse a la dificultad para detectar disfunción familiar con el test de APGAR.ObjectivesThe main purpose is to describe the relationship between family disfunction and mental disorder. The secondary objective is to know the prevalence and distribution of mental disorders in primary care attended population.DesignA cross-sectional study was conducted in a primary care setting.Patients and methodsRandom sample was selected over 280 subjects from consultant population. The variables (family function, family structure, social and economic conditions and mental disorders) were collected through interview. APGAR test and Mini International Neuropsychiatric Interview test were performed.Results264 patients were finally included (64% women). Mean age was 45,6 years (SD 16,7). Mental disorders were detected in 87 patients (33%). The most prevalent disorders were generalized anxiety disorder, dysthymia and major depression. family disfunction was found in 32 patients (12,3%). Prevalence of mental disorders wasn't statistically different in the group with family disfunction.ConclusionMental disorders are a common problem between primary care attended population. There wasn't any association between family disfunction and mental disorders, because of the limitations in the APGAR test in detecting family disfunction

Investigación cualitativa en mujeres víctimas de violencia de género

ObjetivoAnalizar la experiencia de mujeres víctimas de la violencia de género atendidas en centros de atención primaria desde el punto de vista de las mujeres.DiseñoInvestigación cualitativa interpretativa. Perspectiva fenomenológica.EmplazamientoEstudio multicéntrico en centros de salud urbanos.ParticipantesMujeres víctimas de la violencia de género (física, psíquica, sexual)atendidas en los centros de salud. Muestreo intencional y teórico hasta el punto de saturación. Criterios de segmentación: edad (jóvenes-edad media-ancianas); maltrato actual o pasado; detección en urgencies-consultas.Mediciones principalesRelatos biográficos y análisis de contenido de la transcripción literal de las grabaciones. Codificación mediante programa NUD-IST. Utilización para la interpretación de la Teoría Fundamentada.LimitacionesComplejidad del fenómeno de estudio. Proyección de la perspectiva del investigador. Volumen ingente de datos. Se proponen estrategias para mejorar la credibilidad, la conformabilidad y la transferibilidad.Aplicabilidad prácticaMejorar el conocimiento de la situación de las mujeres víctimas de la violencia doméstica desde una perspectiva no directiva, lo que permitirá mejorar la calidad de las intervenciones.ObjectiveTo analyse, from the point of view of the women, the experience of women who are victims of male violence and attended at primary care centres.DesignInterpretative, qualitative research. Phenomenological perspective.SettingMulti-centre study in urban health centres.ParticipantsWomen victims of male violence (physical, psychological, or sexual) seen at health centres. Intention andtheoretical sampling to saturation point.Segmentation criteria: age (young/middle-aged/elderly); current or past ill-treatment; detection in casualty/consultations.Main measurementsBiographical accounts and content analysis of recordings’ literal transcription. Coding through the NUDIST programme. Use for interpreting Well-Founded Theory.LimitationsComplexity of the phenomenon under study. Projection of researcher’s perspective. Huge amount of data. Strategies are proposed for increasing credibility, conformity and transferability.Practical useTo improve understanding of the situation of women who are victims of domestic violence, from a non-directive perspective that enables the quality of interventions to be improved

The need to address fragmentation and silos in mortality information systems: the case of Ghana and Peru

Objectives: We aimed to understand the information architecture and degree of integration of mortality surveillance systems in Ghana and Peru. Methods: We conducted a cross-sectional study using a combination of document review and unstructured interviews to describe and analyse the sub-systems collecting mortality data. Results: We identified 18 and 16 information subsystems with independent databases capturing death events in Peru and Ghana respectively. The mortality information architecture was highly fragmented with a multiplicity of unconnected data silos and with formal and informal data collection systems. Conclusion: Reliable and timely information about who dies where and from what underlying cause is essential to reporting progress on Sustainable Development Goals, ensuring policies are responding to population health dynamics, and understanding the impact of threats and events like the COVID-19 pandemic. Integrating systems hosted in different parts of government remains a challenge for countries and limits the ability of statistics systems to produce accurate and timely information. Our study exposes multiple opportunities to improve the design of mortality surveillance systems by integrating existing subsystems currently operating in silos

From public health policy to impact for COVID-19: a multi-country case study in Switzerland, Spain, Iran and Pakistan

Objectives: With the application of a systems thinking lens, we aimed to assess the national COVID-19 response across health systems components in Switzerland, Spain, Iran, and Pakistan. Methods: We conducted four case studies on the policy response of national health systems to the early phase of the COVID-19 pandemic. Selected countries include different health system typologies. We collected data prospectively for the period of January-July 2020 on 17 measures of the COVID-19 response recommended by the WHO that encompassed all health systems domains (governance, financing, health workforce, information, medicine and technology and service delivery). We further monitored contextual factors influencing their adoption or deployment. Results: The policies enacted coincided with a decrease in the COVID-19 transmission. However, there was inadequate communication and a perception that the measures were adverse to the economy, weakening political support for their continuation and leading to a rapid resurgence in transmission. Conclusion: Social pressure, religious beliefs, governance structure and level of administrative decentralization or global economic sanctions played a major role in how countries' health systems could respond to the pandemic

A health systems resilience research agenda: moving from concept to practice.

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public

QUIJOTE scientific results - VIII. Diffuse polarized foregrounds from component separation with QUIJOTE-MFI

We derive linearly polarized astrophysical component maps in the Northern Sky from the QUIJOTE-MFI data at 11 and 13?GHz in combination with the Wilkinson Microwave Anisotropy Probe K and Ka bands (23 and 33?GHz) and all Planck polarized channels (30-353-GHz), using the parametric component separation method B-SeCRET. The addition of QUIJOTE-MFI data significantly improves the parameter estimation of the low-frequency foregrounds, especially the estimation of the synchrotron spectral index, [beta]s. We present the first detailed ?s map of the Northern Celestial Hemisphere at a smoothing scale of 2°. We find statistically significant spatial variability across the sky. We obtain an average value of ?3.08 and a dispersion of 0.13, considering only pixels with reliable goodness of fit. The power-law model of the synchrotron emission provides a good fit to the data outside the Galactic plane but fails to track the complexity within this region. Moreover, when we assume a synchrotron model with uniform curvature, cs, we find a value of cs = ?0.0797 ± 0.0012. However, there is insufficient statistical significance to determine which model is favoured, either the power law or the power law with uniform curvature. Furthermore, we estimate the thermal dust spectral parameters in polarization. Our cosmic microwave background, synchrotron, and thermal dust maps are highly correlated with the corresponding products of the PR4 Planck release, although some large-scale differences are observed in the synchrotron emission. Finally, we find that the ?s estimation in the high signal-to-noise synchrotron emission areas is prior-independent, while, outside these regions, the prior governs the [beta]s estimation.We thank the staff of the Teide Observatory for invaluable assistance in the commissioning and operation of QUIJOTE. The QUIJOTE experiment is being developed by the Instituto de Astrofisica de Canarias (IAC), the Instituto de Fisica de Cantabria (IFCA), and the Universities of Cantabria, Manchester, and Cambridge. Partial financial support was provided by the Spanish Ministry of Science and Innovation under the projects AYA2007-68058-C03-01, AYA2007- 68058-C03-02, AYA2010-21766-C03-01, AYA2010-21766-C03-02, AYA2014-60438-P, ESP2015-70646-C2-1-R, AYA2017-84185-P, ESP2017-83921-C2-1-R, AYA2017-90675-REDC (co-funded with EU FEDER funds), PGC2018-101814-B-I00, PID2019-110610RBC21, PID2020-120514GB-I00, IACA13-3E-2336, IACA15-BE3707, EQC2018-004918-P, the Severo Ochoa Programs SEV-2015- 0548 and CEX2019-000920-S, the Maria de Maeztu Program MDM2017-0765, and by the Consolider-Ingenio project CSD2010-00064 (EPI: Exploring the Physics of Inflation). We acknowledge support from the ACIISI, Consejeria de Economia, Conocimiento y Empleo del Gobierno de Canarias, and the European Regional Development Fund (ERDF) under grant with reference ProID2020010108. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 687312 (RADIOFOREGROUNDS). EdlH acknowledges financial support from the Concepcion´ Arenal Programme of the Universidad de Cantabria. DT acknowledges the support from the Chinese Academy of Sciences (CAS) President’s International Fellowship Initiative (PIFI) with grant no. 2020PM0042. FP acknowledges support from the Spanish State Research Agency (AEI) under grant number PID2019-105552RB-C43. The authors acknowledge the computer resources, technical expertise, and assistance provided by the Spanish Supercomputing Network (RES) node at Universidad de Cantabria. Some of the presented results are based on observations obtained with Planck (http://www.esa.int/Planck), an ESA science mission with instruments and contributions directly funded by ESA Member States, NASA, and Canada. We acknowledge the use of the Legacy Archive for Microwave Background Data Analysis (LAMBDA) and the Planck Legacy Archive (PLA). Support for LAMBDA is provided by the NASA Office of Space Science. Some of the results in this paper have been derived using the HEALPIX package (Gorski ´ et al. 2005), and the HEALPY (Zonca et al. 2019), NUMPY (Harris et al. 2020), EMCEE (ForemanMackey et al. 2013), and MATPLOTLIB (Hunter 2007) PYTHON packages

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted