Distribuição espacial do risco de infecções respiratórias agudas em Angola, no período 2016-2019: uma previsão de contágio por COVID-19

The increase in cases and deaths from acute respiratory infections is a social and economic problem in Angola. With the aim to stratify the occurrence of acute respiratory illnesses, a cross-sectional descriptive study was carried out from 2016 to 2019. This study assessed how the morbidity and mortality variables changed at a national, provincial, and municipal level. Statistical sources were provided with the provincial reports, sickness forms, and district health information software. The morbidity and mortality rates were calculated, strata of high, medium, and low strata were identified. The results were presented on maps. In morbidity, 55.6% of provinces had a high risk, 22.2% with moderate risk and low in each one; in the municipalities, 50% had high risk, 35.2% moderate and 14.7% low. In 5.5% of the provinces the risk of death was high, in 55.5% moderate and in 44.4% below in the municipalities, 38.4% high risk, 33.3% moderate and 28.2% low. In the stratification, it was identified a high risk of morbidity at a provincial and municipality level, although in terms of mortality, there was a predominance of moderate risk in the provinces, and high and moderate in the municipalities. This information is useful for health authorities in the process of organizing and planning of services, in the distribution of human resources and materials for a greater coverage and effectiveness of intersectoral actions in the prevention and control of these diseases.El aumento de casos y muertes por infecciones respiratorias agudas es un problema social y económico en Angola. Para estratificar la aparición de enfermedades respiratorias agudas, se realizó un estudio descriptivo transversal de 2016 a 2019. Se estudiaron las variables de morbilidad y mortalidad a nivel nacional, provincial y municipal. Las fuentes estadísticas fueron los informes provinciales, los formularios de notificación de enfermedades y el software de información de salud del distrito. Se calcularon las tasas de morbilidad y mortalidade, se identificaron estratos de riesgo alto, medio y bajo Los resultados se presentaron en mapas. En la morbilidad, el 55.6% de las províncias tuvieron un riesgo alto, el 22.2% con riesgo moderado y bajo en cada uno;  en los municipios, el 50% tuvieron riesgo alto, el 35,2% moderado y el 14,7% bajo. En el 5,5% de las provincias el riesgo de muerte  fue alto,  en el 55,5% moderado y en el 44,4%  bajo;  en los municipios, el 38,4% tuvo alto riesgo , el 33,3% moderado y el 28,2% bajo. La estratificación, identificó que a nivel de las provincias y municipios había un alto riesgo de morbilidad, mientras que en la mortalidad,  predominó el riesgo moderado en las provincias y alto y moderado en los municípios. Esta información es útil para las autoridades sanitarias en la organización y planificación de servicios, la distribución de recursos humanos y materiales para una mayor cobertura y efectividad de las acciones intersectoriales en la prevención y control de estas enfermedades.O incremento de casos e óbitos de infecções respiratórias agudas constituem um problema social e económico em Angola. Com o objectivo de estratificar a ocorrência das doenças respiratórias agudas, realizou-se um estudo descritivo transversal no período de 2016 a 2019. Foram estudadas as variáveis de morbilidade e mortalidade a nível nacional, provincial e municipal. As fontes estatísticas foram os relatórios provinciais, fichas de notificação de doenças e o Software Distrital de Informação em Saúde. A estratificação de risco da morbilidade e mortalidade das infecções respiratórias agudas, nos níveis provincial e municipal baseou-se no cálculo das taxas e foram identificados estratos de alto risco, médio e baixo e os resultados foram apresentados em mapas. Na morbilidade, 10 províncias tiveram um risco maior, representando 55,6%, o moderado e baixo em 4 (22,2%) para cada; nos municípios, 50 % tiveram maior risco, 35,2 % com risco moderado e 14,7 % com baixo risco. O maior risco de morrer foi em 5,5% das províncias, moderado em 55,5% e baixo em 44,4%; nos municípios, 38,4% tiveram maior risco, 33,3% com moderado e 28,2% com baixo risco. Na estratificação, identificou-se que a nível das províncias e municípios houve maior risco da morbilidade. Quanto a mortalidade, observou-se predomínio de risco moderado nas províncias e o risco alto e moderado, foi observado nos municípios. Esta informação é útil para as autoridades sanitárias na organização e planificação dos serviços, na distribuição de recursos humanos e materiais para uma maior cobertura e efectividade de acções intersectoriais na prevenção e controlo destas doenças

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Prevalencia de enfermedades crónicas diagnosticadas en población inmigrante y autóctona Prevalence of diagnosed chronic disorders in the inmigrant and native population

Objetivo: Estimar la prevalencia de problemas de salud crónicos en inmigrantes y compararla con la de la población autóctona, utilizando la historia clínica electrónica (HCE) de atención primaria (AP). Métodos: Estudio descriptivo transversal con pacientes de 16 y más años incluidos en el sistema sanitario público de la Comunidad de Madrid. Se estimaron prevalencias ajustadas por edad para cada sexo y nacionalidad (agrupada en regiones) a partir de los episodios de atención registrados en la HCE de AP con alguna anotación en 2005 o 2006. Resultados: El 36,8% de la población inmigrante presentaba alguna enfermedad crónica (55,3% de autóctonos) tras ajustar por edad, con más frecuencia en mujeres y en población de origen africano y latinoamericano. Las enfermedades más prevalentes en los extranjeros fueron las alergias (tasa cruda: 10,2%), las lumbalgias (9,1%), problemas crónicos de piel (6,8%) y trastornos mentales (6,4%). Conclusiones: La prevalencia de enfermedades crónicas es menor en la población extranjera y varía según el sexo y la procedencia.<br>Objective: To estimate the prevalence rates of chronic disorders in immigrants and to compare them with those in the native population, based on electronic clinical records in primary care (ECRPC). Methods: We performed a descriptive cross-sectional study in patients aged 16 and over included in the Madrid Regional Public Health System. Age-adjusted prevalence rates for each sex and region were estimated on the basis of medically examined cases registered in the ECRPC with any new data entry made in 2005 or 2006. Results: After age-adjustment, a total of 36.8% immigrants had some chronic health problem (vs. 55.3% natives). These disorders were more frequent among women and among the population from Africa and Latin America. The highest overall prevalence rates in the foreign population were allergy (10.2% crude rate), low-back pain (9.1%), chronic skin problems (6.8%) and mental disorders (6.4%). Conclusions: The prevalence rate of chronic disease is lower in the foreign population and differs according to sex and country of origin

Additional file 3: of Effectiveness of a virtual intervention for primary healthcare professionals aimed at improving attitudes towards the empowerment of patients with chronic diseases: study protocol for a cluster randomized controlled trial (e-MPODERA project)

Informed consent for patients. (DOC 90 kb

Additional file 5: of Effectiveness of a virtual intervention for primary healthcare professionals aimed at improving attitudes towards the empowerment of patients with chronic diseases: study protocol for a cluster randomized controlled trial (e-MPODERA project)

Patient Activation Measure (PAM) questionnaire. (DOCX 16 kb