Adaptación transcultural de un cuestionario para medir la calidad de vida de los pacientes con anticoagulación oral

ObjetivoAdaptar a la cultura y el idioma españoles un cuestionario desarrollado para evaluar la calidad de vida de los pacientes con tratamiento anticoagulante oral (TAO) y medir su validezDiseñoEstudio observacional, descriptivo, de validación de un instrumento de medida de calidad de vida relacionada con la salud. Emplazamiento. Atención primaria y atención especializadaParticipantesUn total de 225 pacientes que incluía a todos los pacientes de nuestro centro que utilizan TAO y una muestra consecutiva de pacientes con TAO del servicio de hematología del hospital de referenciaMediciones principalesTraducción directa,traducción inversa y prueba de validez. Análisis factorial y agrupación por dimensiones de los ítems, análisis de la consistencia interna y análisis de correlación ítem-total de la versión definitiva del cuestionario en españolResultadosLa edad media de los pacientes fue de 65 ± 13 años, el 51,1% era mujer y el 45,8% era controlado en atención primaria. En el estudio de validez se realizó un análisis factorial con la extracción de 5 factores que explican el 41,62% del valor total de la varianza y la obtención de una agrupación diferente de la original, con unvalor de alfa de Cronbach global de 0,82 y de 0,56–0,74 en las diferentes dimensiones y análisis de correlación ítem-total con valores estadísticamente significativos, excepto en la pregunta número 29ConclusionesTras realizar la adaptación a la cultura y el idioma españoles de un cuestionario desarrollado para evaluar la calidad de vida de los pacientes con TAO, se ha obtenido un instrumento útil y válido para nuestro entornoObjectiveTo adapt to Spanish culture and language a questionnaire developed to evaluate the quality of life of patients taking oral anticoagulation treatment (OAT) and to measure its validityDesignA descriptive observation study to validate an instrument to measure health-related quality of lifeSettingPrimary and specialist careParticipants225 patients, all the patients at our centre who were on OAT and a consecutive sample of patients on OAT from the referral hospital's haemotology serviceMain measurementsDirect translation, back- translation, and pilot study. Factor analysis and item-dimension grouping, internal consistency analysis and analysis of the item- total correlation of the definitive version of the questionnaire in SpanishResultsMean age was 65 (SD=13 years); 51% were women; 45.8% were monitored in PC. Validity study: factor analysis extracted 5 factors that explained 41.62% of total variance value and obtained a grouping different from the original; Cronbach's alpha was .82 overall and ran from .56 to .74 in the various dimensions; and item-total correlation analysis had statistically significant values,except for question 29ConclusionsAfter adaptation to Spanish culture and language of a questionnaire developed to evaluate the quality of life of patients taking OAT, it was found to be a useful instrument, valid for use in our milie

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines