Grupo de expertos del PAPPS. Recomendaciones sobre el estilo de vida

Los determinantes de salud primarios y secundarios explican gran parte de la morbimortalidad observada en atención primaria. Se presentan las recomendaciones del Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) de la semFyC, para la promoción de un estilo de vida saludable mediante la metodología de intervención y las actuaciones preventivas en consumo de tabaco, consumo de alcohol, alimentación saludable, actividad física en el tiempo libre, prevención de accidentes de tráfico y sistemas de retención infantil. Se señalan las pautas más comunes de prevención clínica. Se actualizan las recomendaciones, se señalan aspectos novedosos como la definición de consumo de alcohol de bajo riesgo y se pone al día la bibliografía. Para las principales recomendaciones se incluyen tablas específicas que recogen la calidad de la evidencia y la fuerza de la recomendación. Primary and secondary health determinants explain a large part of the morbidity and mortality observed in primary care. The recommendations of the Program of Preventive Activities and Health Promotion (PAPPS) of the semFyC are presented, for the promotion of a healthy lifestyle through intervention methodology and preventive actions in tobacco consumption, alcohol consumption, healthy eating, physical activity in free time and prevention of traffic accidents and child restraint systems. The most common clinical prevention guidelines are outlined. The recommendations are updated, new aspects are pointed out, such as the definition of low-risk alcohol consumption, and the bibliography is updated. For the main recommendations, specific tables are included that show the quality of the evidence and the strength of the recommendation

Professional quality of life and organizational changes: a five-year observational study in Primary Care

<p>Abstract</p> <p>Background</p> <p>The satisfaction and the quality of life perceived by professionals have implications for the performance of health organizations. We have assessed the variations in professional quality of life (PQL) and their explanatory factors during a services management decentralization process.</p> <p>Methods</p> <p>It was designed as a longitudinal analytical observational study in a Health Area in Madrid, Spain. Three surveys were sent out during an ongoing management decentralization process between 2001 and 2005. The professionals surveyed were divided into three groups: Group I (97.3% physicians), group II (92.5% nurses) and group III (auxiliary personnel). Analysis of the tendency and elaboration of an explanatory multivariate model was made. The PQL -35 questionnaire, based on Karasek's demand-control theory, was used to measure PQL. This questionnaire recognizes three PQL dimensions: management support (MS), workload (WL) and intrinsic motivation (IM).</p> <p>Results</p> <p>1444 responses were analyzed. PQL increased 0.16 (CI 95% 0.04 – 0.28) points in each survey. Group II presents over time a higher PQL score than group I of 0.38 (IC 95% 0.18 – 0.59) points. There is no difference between groups I and III.</p> <p>For each point that MS increases, PQL increases between 0.44 and 0.59 points. PQL decreases an average of between 0.35 and 0.49 point, for each point that WL increases.</p> <p>Age appears to have a marginal association with PQL (CI 95% 0.00 – 0.02), as it occurs with being single or not having a stable relationship (CI 95% 0.01 – 0.41). Performing management tasks currently or in the past is related to poorer PQL perception (CI 95% -0.45 – -0.06), and the same occurs with working other than morning shifts (CI 95% -0.03 – -0.40 points).</p> <p>PQL is not related to sex, location of the centre (rural/urban), time spent working in the organization or contractual situation.</p> <p>Conclusion</p> <p>With the improvement in work control and avoiding increases in workloads, PQL perception can be maintained despite deep organizational changes at the macro-management level. Different professional groups experience different perceptions depending on how the changes impact their position in the organization.</p

New insights into the pathogenesis and transmission of Brucella pinnipedialis: systemic infection in two bottlenose dolphins ( Tursiops truncatus)

The emergence of Brucella infections in marine mammals is a growing concern. The present study reports two cases of systemic Brucella pinnipedialis infection detected in bottlenose dolphins (Tursiops truncatus) pair stranded together in the Cantabrian coast of Spain. Both animals showed systemic lesions associated with the Brucella infection, more severe in the younger dolphin, considered the likely offspring of the other individual. Real-time PCR, bacterial culture, and whole-genome sequencing were used to detect and characterize the Brucella strains involved in both dolphins. The phylogenetic analysis performed on the Brucella genomes retrieved revealed that the species involved was B. pinnipedialis (ST25). Both animals resulted seropositive in a commercial multispecies blocking ELISA but tested negative in the standard Rose Bengal test. To the best of our knowledge, this is the first report of a systemic infection resulting in various lesions associated with Brucella pinnipedialis (ST25) in two bottlenose dolphins. It is also the initial isolation of Brucella in the milk of a non-pregnant or non-aborting female cetacean likely stranded with its offspring. These findings provide new insights into the epidemiology and clinical impact of B. pinnipedialis infection in cetaceans and underscore the importance of continued diagnostic surveillance to gain better understanding of brucellosis effects and transmission in marine mammal populations.Este trabajo ha contado con el apoyo de un convenio de colaboración entre la Fundación Oceanogràfic (Valencia), la Consejería de Medio Rural, Ganadería, Pesca, Alimentación y Medio Ambiente del Gobierno de Cantabria y el Centro de Vigilancia Sanitaria Veterinaria (VISAVET) de la Universidad Complutense de Madrid. Este convenio permite la recogida de muestras de cadáveres de cetáceos varados y aporta fondos para la realización de estudios post-mortem. Ignacio Vargas-Castro es beneficiario de una beca FPU del Ministerio de Ciencia, Innovación y Universidades. El trabajo del CITA fue apoyado por el Gobierno de Aragón (Grupo de Investigación A21_23R). André E. Moura recibió el apoyo del Centro Nacional de Ciencia de Polonia (beca de investigación Sonata 2018/31/D/NZ8/02835) y de la Agencia Nacional Polaca de Intercambio Académico (programa NAWA Ulam PPN/ ULM/2019/1/00162).milkBrucella pinnipedialisbottlenose dolphinmarine mammalssystemic infectionhealth surveillancetransmissionwhole-genome sequencingPublishe

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Adsorption, desorption and fractionation of As(V) on untreated and mussel shell-treated granitic material

As(V) adsorption and desorption were studied on granitic material, coarse and fine mussel shell and granitic material amended with 12 and 24 t ha⁻¹ fine shell, investigating the effect of different As(V) concentrations and different pH as well as the fractions where the adsorbed As(V) was retained. As(V) adsorption was higher on fine than on coarse shell. Mussel shell amendment increased As(V) adsorption on granitic material. Adsorption data corresponding to the unamended and shell-amended granitic material were satisfactory fitted to the Langmuir and Freundlich models. Desorption was always <19% when the highest As(V) concentration (100 mg L⁻¹) was added. Regarding the effect of pH, the granitic material showed its highest adsorption (66%) at pH <6, and it was lower as pH increased. Fine shell presented notable adsorption in the whole pH range between 6 and 12, with a maximum of 83%. The shell-amended granitic material showed high As(V) adsorption, with a maximum (99%) at pH near 8, but decreased as pH increased. Desorption varying pH was always <26%. In the granitic material, desorption increased progressively when pH increased from 4 to 6, contrary to what happened to mussel shell. Regarding the fractionation of the adsorbed As(V), most of it was in the soluble fraction (weakly bound). The granitic material did not show high As(V) retention capacity, which could facilitate As(V) transfer to water courses and to the food chain in case of As(V) compounds being applied on this material; however, the mussel shell amendment increased As(V) retention, making this practice recommendable

Adsorption, desorption and fractionation of As(V) on untreated and mussel shell-treated granitic material

As(V) adsorption and desorption were studied on granitic material, coarse and fine mussel shell and granitic material amended with 12 and 24 t ha⁻¹ fine shell, investigating the effect of different As(V) concentrations and different pH as well as the fractions where the adsorbed As(V) was retained. As(V) adsorption was higher on fine than on coarse shell. Mussel shell amendment increased As(V) adsorption on granitic material. Adsorption data corresponding to the unamended and shell-amended granitic material were satisfactory fitted to the Langmuir and Freundlich models. Desorption was always <19% when the highest As(V) concentration (100 mg L⁻¹) was added. Regarding the effect of pH, the granitic material showed its highest adsorption (66%) at pH <6, and it was lower as pH increased. Fine shell presented notable adsorption in the whole pH range between 6 and 12, with a maximum of 83%. The shell-amended granitic material showed high As(V) adsorption, with a maximum (99%) at pH near 8, but decreased as pH increased. Desorption varying pH was always <26%. In the granitic material, desorption increased progressively when pH increased from 4 to 6, contrary to what happened to mussel shell. Regarding the fractionation of the adsorbed As(V), most of it was in the soluble fraction (weakly bound). The granitic material did not show high As(V) retention capacity, which could facilitate As(V) transfer to water courses and to the food chain in case of As(V) compounds being applied on this material; however, the mussel shell amendment increased As(V) retention, making this practice recommendable

Recomendaciones sobre el estilo de vida. Actualizacón PAPPS 2018 [Recommendations on lifestyle. PAPPS Update 2018]

Intervención sobre el estilo de vida Múltiples estudios demuestran que determinados cambios en el estilo de vida son eficaces para mejorar la salud de las personas y disminuir la carga de enfermedad. La evidencia sobre las intervenciones para el cambio de conducta (ICC) en las consultas de atención primaria (AP) ha ido aumentando en los últimos años, y las estrategias útiles son las cognitivo-conductuales. Las ICC más intensivas se asocian con mayor magnitud y duración del beneficio. Las intervenciones individuales sobre un solo factor de riesgo tienen escaso impacto en la salud de las personas y sus determinantes, por lo que se aconseja el abordaje integral de las conductas susceptibles de cambio para mejorar el estilo de vida. Aunque no han demostrado mejorar los resultados, se recomienda el uso de materiales didácticos impresos como apoyo a las intervenciones breves..