On What Do the Homeless Base Their Happiness?

Objective: To determine the relationship between the characteristics and experiences of homeless persons and their state of happiness as a basis for designing appropriate social support strategies. Design: Exploratory observational study with an analytical and descriptive qualitative design. Setting: Participants were contacted, administered with questionnaires, and interviewed in the street (central and northern areas of the city) or at the “Asociación Calor y Café” center in Granada (Spain) between April 2017 and February 2018. Participants: Selected by intentional sampling, 25 participants completed questionnaires in the first study and 14 of these were administered with questionnaires and interviewed in the second study. Method: General and specific questionnaires were administered to determine the state of happiness and other variables. Descriptive statistics were followed by an analysis of the relationships between variables and the content analysis of semi‐structured interviews. Results: A feeling of happiness was described by 64% of participants and confirmed by a happiness scale score of 50%. Participants who felt satisfied with their life were 4.5‐fold more likely to feel happy (p = 0.021). Expectations for the future were not associated with happiness or satisfaction with life. Content analysis of interviews revealed three main themes: conditions for happiness, own happiness/unhappiness, and self‐esteem. Conclusions: Many homeless people describe themselves as feeling happy and satisfied with their life. Material aspects, affective situations, daily life concerns, and self‐esteem predominate in their discourse on happiness

Analysis of quality antimicrobial agent use in the emergency department of a tertiary care hospital

[Objetivo] Describir los factores modificables relacionados con el tratamiento antimicrobiano (TA) inadecuado en el área de observación de urgencias (AOU), que se puedan constituir en dianas de intervención para un programa de optimización del uso de antimicrobianos (PROA) específico en el servicio de urgencias (SU).[Métodos] Estudio transversal de puntos de prevalencia seriados (PPS) de todas las prescripciones antimicrobianas de los pacientes ingresados en el AOU de febrero a marzo de 2015. La variable principal fue la inadecuación del TA evaluada en base a la guía local de referencia por dos evaluadores.[Resultados] Se analizaron 406 TA. Los principales síndromes clínicos encontrados fueron: neumonía (24%), infecciones urinarias (22%) e infecciones del tracto respiratorio inferior no neumónicas (22%). El 51,5% de los TA fue inadecuado. La falta de obtención de muestras microbiológicas antes del TA (61%), no describir el «foco infeccioso» en la historia clínica del paciente (73%) y la ausencia de criterios de sepsis (58%) se asociaron a un TA inadecuado.[Conclusiones] El TA adecuado fue inferior al 50%. La presentación grave del cuadro infeccioso, el registro del foco en la historia clínica y la obtención de muestras microbiológicas se relacionaban independientemente con una mejor calidad en la prescripción antimicrobiana. Estos factores pueden constituir dianas para el desarrollo de un PROA específico en el SU.[Objective] To describe modifiable factors related to inappropriate antimicrobial treatment in the observation area of an emergency department to explore practices that can be targeted for change through a program to improve emergency use of antimicrobial agents, the PROA program in its spanish observations.[Methods] Cross-sectional serial point-prevalence study of all antimicrobial prescriptions for patients under observation in the department in February and March 2015.The main outcome measure was the frequency of antimicrobial treatment that was inappropriate according the center’s guidelines. Two evaluators assessed appropriateness.[Results] We analyzed 406 antimicrobial treatments. The main clinical syndromes were pneumonia (24%), urinary infections (22%), and nonpneumonia lower respiratory infections (22%). We found that 51.5% of the antimicrobial treatments were inappropriate. Factors associated with inappropriate prescriptions were a failure to analyze microbiologic samples before treating (61%), failure to specify the focus of infection in the case records (73%), and failure to meet the definition of sepsis (58%).[Conclusions] Fewer than half the antimicrobial treatments were appropriate as prescribed. Signs of serious infection, specification of the focus of infection in the patient’s records, and the analysis of biologic samples were independent predictors of quality care (appropriate antimicrobial prescription). These factors can be targeted for training in the development of a specific emergency department program to improve this aspect of care.Artículo financiado por el Plan Nacional de I+D+i 2013‐2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Red Española de Investigación en Patología Infecciosa (REIPI RD12/0015/0010 and REIPI RD16/0016/0001) y co-financiado por el Fondo Regional Europeo “A way to achieve Europe, Operative Programme Intelligent Growth 2014‐2020”.Peer reviewe