The Need for Unification and Harmonization in a Maritime Licensing Standard for Recreational Craft

The objective of this document is to make clear the importance of simplifying the transit of pleasure boats and their skippers safely in the European territory with the foreseeable improvement of the functioning of the internal market. In many European countries recreational skippers are required to have specific training and experience in order to demonstrate their maritime competence. These licenses for navigation allow a recreational vessel to be skippered in each national territory. One of the main objectives of these qualifications is to reduce the number of accidents in recreational boating. Generally speaking, in the European Union, as regards the requirements for the management of pleasure craft, both private and professional, the requirements are very different depending on the member state

Prevalencia y factores de riesgo de úlceras por presión

ObjetivoConocer la prevalencia de úlceras por presión (UPP) en pacientes incapacitados de una Zona Básica de Salud (ZBS) y caracterizar los factores de riesgo asociados a su aparición.DiseñoEstudio transversal observacional.EmplazamientoZBS Rincón de la Victoria (Málaga).ParticipantesPacientes incluidos en el Programa de Incapacitados (n = 178), de la ZBS, residentes en su domicilio o en una residencia geriátrica.MedicionesCuestionario específico con variables sociodemográficas y de salud. Para la valoración de factores de riesgo asociados con la formación de UPP, se utilizó la Escala de Norton Modificada (ENM). La variable resultado de interés fue la presencia o ausencia de UPP, localización y grado. El denominador para el cálculo de la prevalencia ha sido el total de pacientes valorados.ResultadosLa prevalencia fue del 12,9%. La característica sociodemográfica más significativa asociada con la presencia de úlceras en estos pacientes fue el nivel de instrucción del cuidador. Se constata asociación de determinadas variables del estado de salud del paciente con aparición de UPP.ConclusionesLos resultados alertan a la necesidad de la realización de protocolos diagnósticos y de intervención comunitaria para reducir la presentación de UPP en pacientes incapacitados que viven en la comunidad.ObjectivesTo study prevalence of pressure ulcers among functionally impaired patients in the community and evaluate risk factors associated with the development of pressure ulcers in these patients.DesignCross-sectional, observational study.SettingCommunity dwellers served by the Primary Health Care Area of Rincón de la Victoria in Málaga.ParticipantsAll patients included in the «Impaired Patient Programme» (n=178).MethodsA questionnaire was developed to ascertain demographic and health characteristics. Risk factors were evaluated with the Modified Norton Scale. The outcome variable of interest was presence or absence of pressure ulcers, their location and grade. The denominator used for the calculation of the prevalence was the total of evaluated patients.ResultsPrevalence of pressure ulcers in our Basic Health Area was 12.9%. The most important sociodemographic characteristic associated with the presence of pressure ulcers in these patients was the educational attainment of the caregiver. Health varaibles of the patient were also associated with the risk of developing ulcers.ConclusionsResults indicate the need of diagnostic protocols with standardised instruments and prevention plans to reduce pressure ulcers in the community. Longitudinal studies are needed to evaluate interventions in this area

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries