[Evolution of sedentarism prevalence in Spanish population between 1987 and 2020]

BACKGROUND AND OBJECTIVE

Sedentary behavior is a predictive factor for numerous diseases. The objective of this study was to assess the evolution of the prevalence of sedentary behavior in the Spanish adult population between 1987 and 2020.

METHODS

The data sources were the National and European Health Surveys. The prevalence of sedentary behavior was assessed in three scenarios (main activity, leisure time and all scenarios). Prevalence of sedentary behavior was estimated overall, by sex and age group. In all scenarios, prevalence was also estimated by Autonomous Community. The prevalence trend was analyzed with the annual percent change (APC) obtained through joinpoint models.

RESULTS

The prevalence of sedentary in the main activity ranged from 31.2% in 1987 to 38.4% in 2020 [PCA: 0.7 (0.5-1.0)], being higher in men than in women and higher in younger and older people. The prevalence of sedentary in the leisure time varied between 55.1% in 1993 and 36.4% in 2020 [PCA: -1.4 (-1.9 to -0.9)], being always higher in women, higher in those over 64 years of age and lower in those aged 16-24 years. Cantabria and the Canary Islands were the Autonomous Communities with the lowest prevalence of sedentary behavior in all scenarios.

CONCLUSIONS

The prevalence of sedentary behavior in the main activity is increasing in Spain, whereas during leisure time it is decreasing. It is important to implement prevention and health promotion measures aimed at reducing sedentary behavior in the population.

Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey

OBJECTIVE

Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities.

DESIGN

Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019.

SETTING

International study conducted in 78 countries.

PARTICIPANTS

Physicians working in ICU.

INTERVENTIONS

None.

MAIN VARIABLES OF INTEREST

Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training.

RESULTS

466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction.

CONCLUSION

ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.

Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey

OBJECTIVE

Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities.

DESIGN

Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019.

SETTING

International study conducted in 78 countries.

PARTICIPANTS

Physicians working in ICU.

INTERVENTIONS

None.

MAIN VARIABLES OF INTEREST

Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training.

RESULTS

466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction.

CONCLUSION

ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.

[Gender analysis of the Spanish Fertility Survey 2018]

OBJECTIVE

To analyze the language and content of the questionnaire used in the Fertility Survey 2018, from a gender perspective.

METHOD

Qualitative design based on a content analysis of the questionnaire used in the Fertility Survey 2018. Methodological recommendations and guides for gender-sensitive statistics were used, together with the comparison established with the Generations and Gender Survey. The categories of analysis were: language, sexual division of labor and fertility. The analysis procedure included the checklist and the incorporation of emerging variables specifically related to gender inequalities and biases.

RESULTS

The questionnaire uses with some inclusive language, but maintains the generic use of masculine gender, reproduces gender stereotypes and uses male-female binomials as a single concept. It offers a limited perspective on sexual division of domestic and care labor, horizontal and vertical segregation in the workplace, gender differences between the access and control of resources. In relation to fertility, it reproduces gender inequalities and biases that build a normalized and idealized vision on having children, do not reflect the differential impact of pregnancy and parenting on women's health and prioritize the biological dimension of motherhood and fatherhood.

CONCLUSIONS

The Spanish Fertility Survey needs to improve its gender sensitivity, reflect the heterogeneous biological, socio-economic and structural dimensions of fertility and explore deeper into the differential elements that generate inequalities and gender biases.

[Influence of the covid-19 pandemic period of alert on perceived quality of hospital emergencies]

Objetivo

Valorar los cambios en la calidad percibida por los pacientes que precisaron atención urgente hospitalaria antes y durante el periodo de alarma por la pandemia covid-19.

Métodos

Estudio observacional descriptivo retrospectivo usando Net Promoters Score (NPS), que clasifica a los pacientes como promotores o detractores. Se midieron 3 dimensiones de calidad percibida (accesibilidad, profesionales e información) en 160 pacientes dados de alta a domicilio antes del periodo de alarma y en otros 160 en los primeros 2 meses durante ella. Se comprobó, mediante aceptación de lotes (LQAS), un estándar ≥90% promotores y ≤10% detractores, en diferentes vías de acceso y horarios. Los factores relacionados con la probabilidad de que un paciente fuera promotor o detractor se analizaron mediante regresión logística.

Resultados

La puntuación media fue menor en accesibilidad que en las otras dimensiones (8,6 vs. 9,1 y 9,0; p < 0,0001). La accesibilidad obtuvo mejores resultados durante el estado de alarma (NPS 70 vs. 32; p < 0,001). Respecto a la vía de acceso, mejoraron infantil y oftalmología. Maternal no experimentó cambios. En LQAS, se aceptaron más lotes durante la alarma (85 vs. 72%).

La probabilidad de que un paciente fuera promotor fue mayor durante la alarma (OR 1,85; p < 0,0001) y en la dimensión accesibilidad (OR 3,08; p < 0,0001). La probabilidad de que fuera detractor se redujo (OR 0,54; p< 0,05), también para la dimensión accesibilidad (OR 0,39; p < 0,05).

Conclusiones

La calidad percibida durante el periodo de alarma ha mejorado, en la que su propia declaración es el factor más influyente. La mejora es patente en pacientes pediátricos y oftalmológicos, pero imperceptible en gestantes o traumatología, quizá porque la pandemia ejerció como correctora de la adecuación.

[Citizen perspectives on doctor-prescribed mobile health apps and information and communication technology usage within the Andalusian Healthcare System]

BACKGROUND

As eHealth and mHealth are expanding the concerns about the guarantees that must surround these technologies are increasing.

OBJECTIVE

To get to know the opinion of the public on the use and willingness towards communication with health professionals based on new technologies and the use of health apps recommended by those professionals, while identifying the sociodemographic or health differences within the population.

MATERIAL AND METHODS

A cross-sectional descriptive study conducted within the Andalusian Barometer about Mobile Health Apps based on telephone surveys (2016) focused on Andalusian citizens over 18 years old. A combined multi-stage random sample was used, proportionally distributed by province, type of home, gender, and age group. Sample size n=1069 individuals. Frequency distribution analysis, contingency tables and chi-squared test were performed using SPSS software.

RESULTS

Only 0.7% of citizens, especially those with higher education, have communicated with health professionals using information and communication technologies (ICT). Just over half (55%) of the population who has never communicated in that way would like to do so. Only 1.3% of citizens have ever received any recommendation on health apps given by any health professional, whereas 73.8% would be willing to use a health app recommended by professionals. The population groups that show greater willingness in both issues are those citizens under 44 years old, students or citizens with secondary or higher education, active working population, citizens with good or very good health condition, and those without any chronic disease diagnosed. No significant differences were found as regards the variables of gender, type of home, or living with people with disabilities.

CONCLUSIONS

Although there is a high willingness by citizens to use ICT in professional-patient relationships, and to receive recommendations on health apps, they are still not very common. The results obtained are consistent with previous studies, especially regarding the influence of sociodemographic factors in the use and willingness to use of ICTs and recommended apps.

Ankle fracture controversies: Do the foot and ankle specialists have a different vision?

OBJECTIVE

To analyse the differences in the management of ankle fractures between orthopaedic/trauma surgeons and foot and ankle specialists.

MATERIAL AND METHOD

An e-mail survey was performed asking some of the country's orthopaedic surgeons controversial questions regarding the analysis of 5 clinical cases of different ankle fractures.

RESULTS

Seventy-two surgeons responded to the questionnaire (response rate of 24.2%): 37 foot and ankle specialists and 35 non-specialist orthopaedic surgeons. For trimalleolar fracture, 40.5% of the specialists would request a computed tomography scan compared to 14% of the non-specialists (P=.01). Ninety-four percent of all the respondents would synthesise the posterior malleolus; 91% of the non-specialists would use an antero-posterior approach, either with a plate or with screws (P=.006). No differences were found between groups in the treatment of syndesmotic injuries (P>.05). For trans-syndesmotic fracture (Weber B) with signs of medial instability, 54% of the non-specialists would revise the internal lateral ligament compared to only 32% of the specialists (P=.06).

CONCLUSIONS

The foot and ankle specialists ask for more complementary tests to diagnose ankle fractures. In turn, they use a greater diversity of surgical techniques in synthesis of the posterior malleolus (posterior plate) and the medial malleolus (cerclage wires). Finally, they indicated a lower revision rate of the internal lateral ligament.

Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone

OBJECTIVE

To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU.

DESIGN

A prospective, 5-month observational and descriptive study was carried out.

SETTING

ICU of Marqués de Valdecilla University Hospital, Santander (Spain).

SUBJECTS

Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives.

INTERVENTION

Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers.

RESULTS

An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement.

CONCLUSIONS

The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.

[Sexually transmitted infections in male prison inmates: risk of development of new diseases]

OBJECTIVE

To measure incidence and main risk factors related to sexually transmitted infections (STIs) in Daroca Prison (Zaragoza, Spain).

METHOD

A retrospective cohort study (2005-2013) to measure the incidence of STI and a cross-sectional study to measure risk factors.

RESULTS

Of the 203 inmates, 79 developed an STI, 37 had a previous STI, 55.2% lacked knowledge on STI prevention, and 28.9% showed behaviours unfavourable for STI prevention. The incidence rate was 6.5 STIs per 1,000 inmates-year. The most frequent STIs were hepatitis B (39.7%), Ureaplasma urealyticum (19.1%), herpes simplex (16.2%) and HIV (8.8%). The risk (hazard ratio, HR) of acquiring a new STI was significantly higher in inmates with a history of previous STI (HR=2.61; 95%CI: 1.01 to 6.69), and was at the limit of significance for non-preventive behaviour (HR=2.10; 95%CI: 0.98 to 4.53), but not in knowledge related to STIs (HR=1.33; 95%CI: 0.58 to 3.07).

CONCLUSION

The most important risk factors in prison are behaviours related to STIs and previous history of STIs. Other factors are being a repeat offender, injecting drug use, or being in a methadone programme. Health personnel and peer education can facilitate prevention and control.

[Difficulties with the prescription and administration of antibiotics in routine hospital emergency department care: a survey study]

OBJECTIVES

To detect the problems hospital emergency room staff have when prescribing and administering antibiotics.

MATERIAL AND METHODS

A 14-item questionnaire was designed to assess staff members' knowledge of the importance of starting antibiotic treatment promptly, assigning appropriate dosing intervals, adjusting for renal function, and switching to oral therapy. Agreement with each item was expressed on a 5-point Likert scale. Items with a rate of appropriate response of less than 75% were targeted for specific attention.

RESULTS

Two hundred questionnaires were distributed to the staff and 150 were returned completed (response rate, 75%). The following items were targeted for attention based on rates of appropriate response of less than 75%: clear medical orders (65%), understanding the implication of early empirical antibiotic therapy on prognosis in serious infections (67%), estimation of the prevalence of renal insufficiency (42%), assumption that a creatinine serum level under < 1.6 mg/dL is safe (33%), use of glomerular filtration rate to adjust dose according to renal function (47%), and an understanding of switching from intravenous to oral treatment (60%).

CONCLUSION

This study revealed the difficulties medical and nursing staff have in prescribing and administering antibiotics in a hospital emergency department. The results can facilitate improvements in antibiotic therapy by pinpointing areas to target for specific training interventions or the design of electronic prescribing aids.

Self-assessed efficacy of a clinical musculoskeletal anatomy workshop: A preliminary survey

OBJECTIVE

To survey the efficacy of a practical workshop on clinical musculoskeletal anatomy held in five American countries.

METHODS

A self-assessment competence questionnaire sent to participants 1-3 months after the workshop. Results were compared to the results of a practical, instructor-assessed, pre-workshop test.

RESULTS

The response rate of participants was 76.4%. The overall, self-assessed competence score for anatomical items that had been included in the pre-test was 76.9 (scale 0-100) as compared to an overall score of 48.1 in the practical, pre-workshop test (p<0.001). For items that were addressed in the workshop, but not included in the pre-test, self-assessed competence was rated at 62.9. Differences in anatomical knowledge between individuals from different countries and professional groups noted in the practical pre-test were no longer present in the post-test self-assessment.

CONCLUSIONS

From this preliminary data and supporting evidence from the literature we believe that our anatomy workshop provides an effective didactic tool for increasing competence in musculoskeletal anatomy.

Migraine education brochures and patient-perceived satisfaction

INTRODUCTION

Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received.

OBJECTIVES

This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine.

MATERIAL AND METHODS

Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure.

RESULTS

We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control.

CONCLUSIONS

Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement.

[Measuring the satisfaction of patients admitted to the intensive care unit and of their families]

OBJECTIVE

To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU.

DESIGN

A prospective, observational and descriptive study with a duration of 5 months was carried out.

SETTING

The ICU of Marqués de Valdecilla University Hospital, Santander (Spain).

SUBJECTS

Family members of adult patients admitted to the ICU and patients discharged to the ward.

INTERVENTION

INSTRUMENT

Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients.

RESULTS

A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46 ± 11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85).

CONCLUSIONS

The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative.

[Pediamécum: one year of experience]

In 2011, the Spanish Association of Pediatrics decided to support the most ambitious project of its newly created Committee for Medicinal Products: Pediamécum. This is the first free on-line database with information on medicinal products for pediatric use in Spain. The web page http://pediamecum.es/ started on December 17 December 2012. One year later, Pediamécum includes 580 registered drugs. The website achieved more than one million page views by the end of 2013. Because of the first anniversary of Pediamécum, a survey was performed to request the feeling of users. Four hundred eighty-three responses were obtained. Ninety-five percent believed that it is easy to navigate through the web, and 74% said that their doubts about the use of medicines in children were always resolved. The overall rating of Pediamécum is 7.5/10. The aims of Pediamécum are being accomplished; which is reflected essentially due to it becoming a useful tool for all professionals who care for children in their daily clinical practice.

[Personalizing the reference level: gold standard to evaluate the quality of service perceived]

OBJECTIVE

To know the cutoff point at which in-house Nuclear Medicine Department (MND) customers consider that the quality of service is good (personalized cutoff).

MATERIAL AND METHOD

We conducted a survey of the professionals who had requested at least 5 tests to the Nuclear Medicine Department. A total of 71 doctors responded (response rate: 30%). A question was added to the questionnaire for the user to establish a cutoff point for which they would consider the quality of service as good. The quality non-conformities, areas of improvement and strong points of the six questions measuring the quality of service (Likert scale 0 to 10) were compared with two different thresholds: personalized cutoff and one proposed by the service itself a priori. Test statistics: binomial and Student's t-test for paired data.

RESULTS

A cutoff value of 7 was proposed by the service as a reference while 68.1% of respondents suggested a cutoff above 7 points (mean 7.9 points). The 6 elements of perceived quality were considered strong points with the cutoff proposed by the MND, while there were 3 detected with the personalized threshold. Thirteen percent of the answers were nonconformities with the service cutoff versus 19.2% with the personalized one, the differences being statistically significant (difference 95% CI 6.44%:0,83-12.06).

CONCLUSIONS

The final image of the perceived quality of an in-house customer is different when using the cutoff established by the Department versus the personalized cutoff given by the respondent.