Open Access
Accelerated bacterial identification with MALDI-TOF MS leads to fewer diagnostic tests and cost savings
(MDPI, 2024-12-02) Uzuriaga, Miriam; Guillén Grima, Francisco; Rua, Marta; Leiva, José; Yuste, José R.; Ciencias de la Salud; Osasun Zientziak
Introduction: Rapid microbiology reporting can enhance both clinical and economic outcomes. Material and Methods: This three-year, quasi-experimental study, single-group pretest¿posttest study, conducted at a university medical center, aimed to evaluate the clinical and economic impact of rapid microbiological identification reporting using MALDI-TOF MS. A total of 363 consecutive hospitalized patients with bacterial infections were evaluated, comparing a historical control group (CG, n = 183) with an intervention group (IG, n = 180). In the CG, microbiological information (bacterial identification and antibiotic susceptibility) was provided between 18:00 and 22:00 h, while in the IG, bacterial identification was reported between 12:00 and 14:00 h, and antibiotic susceptibility was reported between 18:00 and 22:00 h. Results: The IG demonstrated a significant reduction in the number of patients undergoing Microbiology (p = 0.01), Biochemistry (p = 0.05), C-Reactive Protein (p = 0.02), Radiological Tests (p = 0.05), Computed Tomography Tests (p = 0.04), and Pathology (p = 0.01). However, no statistically significant reduction was observed in economic costs related to microbiological testing (p = 0.76) or antibiotic consumption (p = 0.59). The timely reporting of microbiological identification to clinicians resulted in fewer patients undergoing additional diagnostic tests, ultimately contributing to reduced healthcare resource utilization without adversely affecting clinical outcomes.
Open Access
Production of vegetables and artichokes is associated with lower cardiovascular mortality: an ecological study
(MDPI, 2020) Arnedo Pena, Alberto; Puig Barberà, Joan; Bellido Blasco, Juan; Romeu García, María Ángeles; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Mortality due to cardiovascular disease (CVD), including cerebrovascular disease (CED) and ischaemic heart disease (IHD), was considerably different in eight municipalities of the province of Castellón, Community of Valencia (Spain) during the period of 1991–2011. In addition, these villages showed differences in agricultural practices and production. Since high vegetable consumption has been linked to decreased all-cause, CVD, and CED mortalities, we hypothesized that the diversity in vegetable and artichoke production, used as proxies for their consumption, could be associated with the diversity of mortality rates. In order to test our hypothesis, we estimated the smoothed standardized mortality ratios (SMRs) of CVD, CED, and IHD mortalities and a directed, age-adjusted mortality rate (AMR). We used a multilevel linear regression analysis to account for the ecological nature of our study. After adjustment, the CVD and CED SMRs were inversely associated with vegetable and artichoke production, with a reduction in SMRs for CVD: −0.19 (95% Confidence Interval [CI] −0.31 to −0.07) and −0.42 (95% CI −0.70 to −0.15) per hectare/103 inhabitants, respectively. The SMRs for CED also decreased: −0.68 (95% CI −1.61 to −0.19) and −1.47 (95% CI −2.57 to −0.36) per hectare/103 inhabitants, respectively. The SMRs for IHD were not associated with vegetal and artichoke production. When the directed AMR was used, CED mortality was consistent with the previous results, whereas the CVD mortality association was lost. Our results indicate that vegetable and artichoke production may act as protective factors of CED and CVD mortalities.
Open Access
Maternal mortality in Africa: regional trends (2000-2017)
(MDPI, 2022) Onambele, Luc; Ortega-Leon, Wilfrido; Guillén Aguinaga, Sara; Forjaz, Maria Joao; Yoseph, Amanuel; Guillén Aguinaga, Laura; Alas Brun, Rosa María; Arnedo Pena, Alberto; Aguinaga Ontoso, Inés; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Background: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa’s leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. Methods: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children’s Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of −3.0% (95% CI −2.9; −3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations’ sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. Conclusions: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations’ target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.
Open Access
Negative consequences of substance use in European university students: results from Project SNIPE
(Karger, 2020) McAlaney, John; Dempsey, Robert C.; Helmer, Stefanie M.; Hal, Guido van; Bewick, Bridgette M.; Akvardar, Yildiz; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Background: University students are a risk group for heavy substance use and the experience of various potentially severe negative substance use consequences which may impact on their health, social, and academic functioning. Whilst the experience of negative consequences of substance use is well understood in North American student samples, there is little data on these experiences in European students. In order to develop effective harm prevention and reduction interventions for students' substance use, there needs to be an understanding of the types of consequences experienced in European student samples. Objectives: The aim of the study was to investigate the prevalence and predictors of the experience of negative substance use-related consequences amongst university students in 7 European countries. Methods: University students (n = 4,482) in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the UK completed an online survey of their substance use behaviours and the experience of associated negative consequences. Results: European students reported that experiencing a hangover or illness, missing class, being short of money, and experiencing memory loss were the most commonly experienced negative consequences of substance use. Not living with other students and using alcohol, cannabis, sedatives, and cocaine were also associated with higher odds of experiencing these negative consequences. Conclusions: In contrast to North American data, European university students tended to experience consequences that are associated with lower level health risks rather than more severe consequences (e.g., drink-driving and physical injury). Harm prevention and reduction interventions for students should be targeted towards those consequences that are most salient to the target group to ensure feedback is relevant and potentially more effective in changing students' substance use behaviours.
Open Access
Individual- and community-level determinants of maternal health service utilization in southern Ethiopia: a multilevel analysis
(SAGE, 2023) Yoseph, Amanuel; Teklesilasie, Wondwosen; Guillén Grima, Francisco; Astatkie, Ayalew; Ciencias de la Salud; Osasun Zientziak
Background: Maternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia. Objectives: This study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia. Design: A community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region. Methods: Data were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization. Results: Utilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73). Conclusion: Maternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.
Open Access
Evaluation of the degradation of materials by exposure to germicide UV-C light through colorimetry, tensile strength and surface microstructure analyses
(Elsevier, 2022) Mitxelena Iribarren, Oihane; Mondragón, Beñat; Pérez Lorenzo, Eva; Smerdou, Cristian; Guillén Grima, Francisco; Sierra-García, J. Enrique; Rodríguez Merino, Fernando; Arana, Sergio; Ciencias de la Salud; Osasun Zientziak
Due to the COVID19 pandemic, solutions to automate disinfection using UV-C combined with mobile robots are beginning to be explored. It has been proved that the use of these systems highly reduces the risk of contagion. However, its use in real applications is not being as rapid as it needs to be. One of the main market input barriers is the fear of degrading facilities. For this reason, it is crucial to perform a detailed study on the degradation effect of UV-C light on inert materials. This experimental study proves that, considering exposition times equivalent to several work years in hospital rooms, only the appearance of the material is affected, but not their mechanical functionalities. This relevant result could contribute to accelerate the deployment of these beneficial disinfection technologies. For that purpose, a colorimetry test, tensile strength test, and analysis of the surface microstructure were carried out. The results showed that polymers tend to turn yellow, while fabrics lose intensity depending on the color. Red is hardly affected by UV-C, but blue and green are. Thus, this study contributes to the identification of the best materials and colors to be used in rooms subjected to disinfection processes. In addition, it is shown how the surface microstructure of the materials is altered in most of the materials, but not the tensile strength of the fabrics.
Open Access
Schizophrenia and hospital admissions for cardiovascular events in a large population: the APNA study
(MDPI, 2022) Guillén Aguinaga, Sara; Brugos Larumbe, Antonio; Guillén Aguinaga, Laura; Ortuño, Felipe; Guillén Grima, Francisco; Forga, Lluís; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
(1) Background: patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: the APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031–1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267–3.933). (4) Conclusions: patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.
Open Access
Incidence and risk factors of the COVID-19 pandemic: an epidemiological approach
(MDPI, 2023) Arnedo-Pena, Alberto; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
After three years of the COVID-19 pandemic, its significant impact on global health is evident, with varying mortality, incidence, and fatality rates across different regions. Studies estimate over 40% of the world's population has been infected. The pandemic has disproportionately affected low-income countries and vulnerable groups. A Special Issue in Epidemiologia focused on the epidemiology of COVID-19, examining high-risk groups, including long-term care home residents and staff, healthcare workers, and patients with chronic mental illness. Findings highlighted factors influencing COVID-19 incidence and mortality, such as facility conditions and staff ratios. Despite vaccination efforts reducing the severity of infections, transmission remains high, and ongoing research is crucial to manage new variants and future pandemics.
Open Access
Incidence, hospitalization, mortality and risk factors of COVID-19 in long-term care residential homes for patients with chronic mental illness
(MDPI, 2022) Arnedo Pena, Alberto; Romeu García, María Ángeles; Gasco-Laborda, Juan Carlos; Meseguer-Ferrer, Noemí; Safont-Adsuara, Lourdes; Guillén Grima, Francisco; Tirado-Balaguer, María Dolores; Sabater-Vidal, Susana; Gil-Fortuño, María; Pérez-Olaso, Óscar; Hernández-Pérez, Noelia; Moreno-Muñoz, Rosario; Bellido Blasco, Juan; Ciencias de la Salud; Osasun Zientziak
Long-term care residential homes (LTCRH) for patients with chronic mental illness have suffered the enormous impact of COVID-19. This study aimed to estimate incidence, hospitalization, mortality, and risk factors of COVID-19 to prevent future epidemics. From March 2020 to January 2021 and before vaccination anti-SARS-CoV-2 begins, cumulate incidence rate (CIR), hospitalization rate (HR), mortality rate (MR), and risk factors of COVID-19 in the 11 LTCRH of two Health Departments of Castellon (Spain) were studied by epidemiological surveillance and an ecological design. Laboratory tests confirmed COVID-19 cases, and multilevel Poisson regression models were employed. All LTCRH participated and comprised 346 residents and 482 staff. Residents had a mean age of 47 years, 40% women, and suffered 75 cases of COVID-19 (CIR = 21.7%), five hospitalizations (HR = 1.4%), and two deaths (MR = 0.6%) with 2.5% fatality-case. Staff suffered 74 cases of the disease (CIR = 15.4%), one hospitalization (HR = 0.2%), and no deaths were reported. Risk factors associated with COVID-19 incidence in residents were private ownership, severe disability, residents be younger, CIR in municipalities where LTCRH was located, CIR in staff, and older age of the facilities. Conclusion: COVID-19 incidence could be prevented by improving infection control in residents and staff and modernizing facilities with increased public ownership.
Open Access
Perceptions, barriers, and facilitators of maternal health service utilization in southern Ethiopia: a qualitative exploration of community members' and health care providers' views
(PLoS, 2024-12-19) Yoseph, Amanuel; Teklesilasie, Wondwosen ; Guillén Grima, Francisco; Astatkie, Ayalew; Ciencias de la Salud; Osasun Zientziak
Introduction. Maternal health service (MHS) use is a key strategy to reduce maternal mortality. However, evidence is scarce in designing efficient intervention strategies in Ethiopia. Thus, we aimed to explore community members and healthcare providers’ perceptions of MHS and barriers and facilitators of MHS use in southern Ethiopia. Methods. A phenomenological qualitative study was conducted in the month of November, 2022, in the northern zone of the Sidama region. There were sixteen in-depth interviews, nine focus group discussions, and 15 key informant interviews with 112 study participants. A maximum variance sampling method was used to select study participants. Data coding and analysis were done using MAXQDA 2020 software and presented in narratives. Results. Communities have positive perceptions and good practices of skilled antenatal care (ANC) and health facility delivery (HFD) but lack awareness of postnatal care (PNC) services and schedules. Some have experienced negative interactions with health care providers, health facilities, and ambulance drivers. The main identified barriers to ANC use were lack of awareness of ANC benefits, distance from a health facility, costs associated with ANC use, long waiting time, lack of road access, and women being busy with different household chores. Distance from health facilities, costs associated with HFD use, unpredicted labor, lack of an ANC visit, lack of a birth preparedness plan, and non-dignified care were the main barriers to HFD. The major barriers to PNC use were home delivery, lack of awareness of PNC service and schedule, and socio-cultural beliefs. The main identified facilitators of MHS use were previous experience and fear of obstetric complications, health extension workers and women’s development teams, and pregnant women’s forums. Conclusions. Rural women still encounter challenges when using MHS, even though communities have positive perceptions and good practices of skilled MHS. Bad experiences mothers faced in health facilities, challenges associated with the costs of MHS use, poor awareness of service, and unpredictable labor continued to be fundamental barriers to MHS use. Intervention approaches should consider inter-sectoral collaboration to address community and health facility barriers. The programs must emphasize the transportation arrangements during unpredictable labor and the needs of poor mothers and women with poor awareness of MHS at the community level.