Twenty-four-hour, weekly and annual patterns in serious falls of non-institutionalized independent Spanish seniors.

OBJECTIVE: The study aimed to explore clock hour, day-of-week, and month-of-year patterns of serious falls experienced by non-institutionalized Spanish seniors (age ≥65 years) in relation to associated conventional intrinsic and extrinsic factors. PATIENTS AND METHODS: Intake emergency department records from January 1 to December 31, 2013 of a tertiary hospital of southern Spain were abstracted for particulars of falls, including the time of occurrence, experienced specifically by non-institutionalized seniors. Chi-squares and Single and Multiple-Component Cosinor (time series) Analyses were applied to determine the statistical significance of observed 24-hour, 7-day, and annual variation. RESULTS: Falls were ~2.5-fold more numerous in older women than older men and ~7-fold more frequent between 12:00 and 14:00 hours than ~02:00 hours, respectively, the time spans corresponding to the absolute peak and trough of the 24-hour pattern in falls. The midday/early afternoon peak primarily represented incidents of women ≥75 years of age that occurred inside the home while walking, standing, or moving on stairs. A late evening less prominent excess of mostly inside-the-home incidents of women ≥75 years of age, largely due to fragility, slipping, stumbling, or tripping, was additionally detected. Cosinor Analysis substantiates statistical significance of the 24-hour patterning of falls of men and women (both p<0.001). Day-of-week differences, with prominent Thursday peak and Sunday minimum, were additionally detected, but only for falls of women occurring outside the home (Cosinor Analysis: p=0.007). Day-of-week discrepancy in female/male sex ratio (SR) of fallers was demonstrated, arising from day-of-week disparity in the SR of inside-the-home incidents, with ~4.5-fold more elderly women than elderly men falling Thursday than any other day of the week (p=0.005). Non-statistically significant month-of-year difference in falls, lowest in autumn and highest (~60% more) in winter, was observed and explained by prominent seasonal difference in incidents by elderly women. CONCLUSIONS: Serious falls of non-institutionalized independent seniors are characterized according to intrinsic and extrinsic factors by prominent 24-hour and 7-day patterning. These findings complement the understanding of the epidemiology of falls of the elderly and further inform fall prevention programs

DESCRIPCIÓN Y ANÁLISIS DEL GRADO DE APLICACIÓN DEL PROGRAMA INFORMÁTICO DE CUIDADOS, AZAHAR, EN EL HOSPITAL UNIVERSITARIO REINA SOFÍA DE CÓRDOBA. PLANTEAMIENTO DE NUEVAS LÍNEAS DE ACTUACIÓN

To provide qualitative nursing care starting from a jointly unity criteria was one of the objectives to register and manage the nursing care process through a computer program at the Hospital of Reina Sofia in Cordoba. We present a first assessment on its application.Prestar cuidados enfermeros de calidad a partir de una unidad consensuada de criterio fue uno de los objetivos para registrar y gestionar el Proceso de Atención de Enfermería a través de un programa informático, en el Hospital Reina Sofía de Córdoba. Se presenta una primera evaluación de su grado de aplicació

COVID-19 pandemic on coronary artery and cerebrovascular diseases in Southern Spain: interrupted time series analysis

Objective: Healthcare systems have been put under intense pressure by the COVID-19 pandemic, although some studies have shown a decline in hospital admissions for cardiovascular and cerebrovascular diseases during the first and second wave of the pandemic. In addition, studies analyzing gender and procedural differences are scarce. The present study aimed to determine the impact of the pandemic on hospital admissions for acute myocardial infarction (AMI) and cerebrovascular disease (CVD) in Andalusia (Spain) and analyzed differences by gender and by percutaneous coronary interventions performed. Patients and methods: An interrupted time series analysis of AMI and CVD hospital admissions in Andalusia (Spain) was carried out to measure the impact of the COVID-19 outbreak. AMI and CVD cases admitted daily in public hospitals of Andalusia between January 2018 and December 2020 were included. Results: During the pandemic, significant reductions in AMI [-19%; 95% confidence interval (CI): (-29%, -9%), p<0.001] and CVD [-17%; 95% CI: (-26%, -9%); p<0.01] in daily hospital admissions were observed. Differences were also produced according to the diagnosis (ST-Elevation Myocardial Infarction, Non-ST-Elevation Myocardial Infarction, other AMI and stroke), with a greater reduction in females for AMI and in males for CVD. Although there were more percutaneous coronary interventions during the pandemic, no significant reductions were observed. Conclusions: A decline in AMI and CVD daily hospital admissions during the first and second wave of COVID-19 pandemic was noted. Gender differences were observed, but no clear impact was observed in percutaneous interventions

CHRONOFALLS: A multicentre nurse-led intervention in the chronoprevention of in-hospital falls in adults

Background: Falls are among the most common and serious adverse events for hospitalised patients. In-hospital falls pose a major medical and economic challenge for public health worldwide. Nevertheless, the issue is often addressed without regard to certain relevant variables such as the time of the fall. The aim of this study was to determine the effect of the implementation of a nurse-led intervention based on the temporal patterns of falls and their aetiology on the occurrence of falls. Methods: A mixed-method research design was carried out in three phases: a) a longitudinal prospective study (audits, chronobiological analyses and implementation of a multicentre nurse-led intervention based on temporal patterns of falls); b) a retrospective study of fall records; and c) a qualitative study based on focus groups. The protocol was published in 2021. Results: A difference was observed in the number of fall records before and after the chronopreventive intervention (retrospective: 64.4% vs. 35.6%; p < 0,001). According to the interrupted series analysis, considering the influence of the COVID-19 pandemic, a reduction in falls of 2.96% (95% CI 1.70%-4.17%) was observed. The concepts of falls, the COVID-19 pandemic and the causes of non-registration have emerged as categories for qualitative analysis. Conclusions: A multicentric nurse-led program based on tailored organisational, educational and behavioural chronopreventive measures seems to lead to a reduction in the number of in-hospital falls. The findings of the present study, highlighting the implementation of chronopreventive measures, can serve as a basis for future health policies

La violencia contra las mujeres enfermeras en la pareja. Primeros resultados de un estudio en Andalucía

Aim. To Identify intimate partner violence (IPV) against female nurses in a sample of nurses in Cordoba, Spain.Design. Descriptive, cross-sectional study.Setting. Hospitals and primary health care in Cordoba, Spain.Participants. One hundred and two female nurses working in urban or rural, public or private health centers in Cordoba, Spain.Measures. Social-demographic characteristics and presence of abuse (psychological, physical and sexual).Results. A) A stricter recoding of the parameters of abuse: overall, 47.1% had experienced some type of IPV, of which 41.2% was psychological. B) A more permissible recoding of the parameters of abuse: 25.5% had experienced some type of IPV, of which 19.6% was psychological. C) Both recodings: 2.9% had suffered three types of abuse together (psychological, physical and sexual) and both psychological and sexual IPV; likewise, 11,8% reported more severe or more serious abuse.Conclusion. The existence of intimate partner violence in female nurses was established and it was confirmed that this was expressed through psychological aspects.Objetivo. Identificar violencia contra las mujeres enfermeras en la pareja a partir de una muestra de profesionales que prestan sus servicios en la Provincia de Córdoba.Diseño. Estudio descriptivo transversal.Emplazamiento. Hospitales y distritos sanitarios de la Provincia de Córdoba.Participantes. Mujeres enfermeras que desarrollaban sus actividades profesionales en cualquiera de los sistemas de salud, público o privado, rural o urbano, en la Provincia de Córdoba.Mediciones Principales. Características sociodemográficas y presencia de malos tratos (psíquico, físico y sexual), con el cuestionario validado por Delgado y colaboradores (2006).Resultados. La Recodificación de las variables del maltrato más estricta muestra que el 47,1% del total de enfermeras en la muestra tuvo algún tipo de maltrato, del que el 41,2% fue exclusivamente psicológico. Una Recodificación del maltrato más permisiva indica que el 25,5% tuvo algún tipo de maltrato del que 19,6% fue psicológico. Considerando ambas se puede ver que el 2,9% presentaron los tres tipos juntos (psicológico, físico y sexual) y psicológico acompañado del sexual; así como que el 11,8% presentó un maltrato más severo o de mayor gravedad.Conclusiones. Establecida la existencia de malos tratos en la mujer enfermera se constata que las manifestaciones van referidas al aspecto psicológic

Intimate partner violence among health professionals: distribution by autonomous communities in Spain

Abstract OBJECTIVE To determine the prevalence of intimate partner violence among health care professionals who work in the Spanish National Health System, according to the autonomous communities of Spain. METHOD This was a descriptive cross-sectional multicenter study conducted with male and female health professionals (doctors, nurses, and nursing aides) in the different autonomous communities that are part of the Spanish National Health System. The following instruments were employed: among women, an intimate partner violence screening questionnaire; and among men, a questionnaire that screened for violence in the family environment. RESULTS A total of 1,039 health professionals participated in the study. Of these, 26% had suffered some type of abuse. Among the men, this prevalence was 2.7%, while among the women, it was 33.8%. There were differences in the prevalence of intimate partner violence among different autonomous communities, with the highest percentages in the Canary Islands. In terms of profession, 19.5% of the doctors had been exposed to intimate partner violence, while this percentage was 31% and 48.6% for nurses and nursing professionals, respectively. CONCLUSION The results indicate the presence of intimate partner violence among healthcare personnel in most of the autonomous communities of Spain. The data demonstrate the need to implement action plans, both to support victims and to mitigate the problem

PREVALENCIA DE INFECCIÓN EN LA HERIDA QUIRÚRGICA EN PACIENTE GINECOLÓGICA A LOS DIEZ Y VEINTE DÍAS DE LA INTERVENCIÓN POR LAPAROTOMÍA Y CON ALTA PRECOZ

Longitudinal study (two observations) in 109 gynecological patients that underwent laparotomy surgery and patient early check out and that had received training for self-care at check out. With the objective of knowing the prevalence of surgical wound infection ten or twenty days after the operation and to identify the impact of education for self-care. The procedure for information collection consisted of two semistructured interviews, carried out via telephone, where among other questions they were asked about the characteristics of the wound, the person and the place where the cure was received. The prevalence of the infection was found in 10 % of the patients after ten days and in 5 % after twenty days. The relationship between the variable of the infection, person and where curing took place, make us put special emphasis in valuing the conditions of treatment, and the consequences of multi-personal involvement.Estudio longitudinal (2 observaciones) en 109 pacientes ginecológicas intervenidas por laparotomia y con alta precoz y que habian recibido formación para el autocuidado al alta. Con los objetivos de conocer la prevalencia de infección en la hérida quirurgica a los 10 y 20 días de la intervención y de identificar el impacto de la educación para el autocuidado. El procedimiento de recogida de información consistió en dos entrevistas semiestructuradas, realizadas vía telefónica, donde entre otros aspectos se preguntaba sobre las características de la herida, y la persona y lugar donde se realizaba la cura. La prevalencia de infección se encontró en el 10% a los 10 días y el 5 % a los 20 días. La relación entre la variable signos de infección y persona y lugar de la cura lleva a hacer hincapié en valorar las condiciones en que se realizan la curas y en las consecuencias de la intervención de varias manos en la cura de la herida

The Tyrosine Kinase Pyk-2/Raftk Regulates Natural Killer (Nk) Cell Cytotoxic Response, and Is Translocated and Activated upon Specific Target Cell Recognition and Killing

The compartmentalization of plasma membrane proteins has a key role in regulation of lymphocyte activation and development of immunity. We found that the proline-rich tyrosine kinase-2 (PYK-2/RAFTK) colocalized with the microtubule-organizing center (MTOC) at the trailing edge of migrating natural killer (NK) cells. When polyclonal NK cells bound to K562 targets, PYK-2 translocated to the area of NK–target cell interaction. The specificity of this process was assessed with NK cell clones bearing activatory or inhibitory forms of CD94/NKG2. The translocation of PYK-2, MTOC, and paxillin to the area of NK–target cell contact was regulated upon specific recognition of target cells through NK cell receptors, controlling target cell killing. Furthermore, parallel in vitro kinase assays showed that PYK-2 was activated in response to signals that specifically triggered its translocation and NK cell mediated cytotoxicity. The overexpression of both the wt and a dominant-negative mutant of PYK-2, but not ZAP-70 wt, prevented the specific translocation of the MTOC and paxillin, and blocked the cytotoxic response of NK cells. Our data indicate that subcellular compartmentalization of PYK-2 correlates with effective signal transduction. Furthermore, they also suggest an important role for PYK-2 on the assembly of the signaling complexes that regulate the cytotoxic response

Labor stimulation with oxytocin: effects on obstetrical and neonatal outcomes

Abstract Objective: to evaluate the effects of labor stimulation with oxytocin on maternal and neonatal outcomes. Method: descriptive and analytical study with 338 women who gave birth at a tertiary hospital. Obstetric and neonatal variables were measured and compared in women submitted and non-submitted to stimulation with oxytocin. Statistics were performed using Chi-square test, Fisher exact test, Student t-test; and crude Odds Ratio with 95% confidence interval were calculated. A p < 0.05 was considered statistically significant. Results: stimulation with oxytocin increases the rates of cesarean sections, epidural anesthesia and intrapartum maternal fever in primiparous and multiparous women. It has also been associated with low pH values of umbilical cord blood and with a shorter duration of the first stage of labor in primiparous women. However, it did not affect the rates of 3rd and 4th degree perineal lacerations, episiotomies, advanced neonatal resuscitation, 5-minute Apgar scores and meconium. Conclusion: stimulation with oxytocin should not be used systematically, but only in specific cases. These findings provide further evidence to health professionals and midwives on the use of oxytocin during labor. Under normal conditions, women should be informed of the possible effects of labor stimulation with oxytocin