Open Access
Urgencias hospitalarias y extrahospitalarias en Navarra. Razones que las motivan
(Gobierno de Navarra, 2009) Pérez Ciordia, Ignacio; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Fundamento. La demanda de asistencia sanitaria urgente está alcanzando cifras cercanas a la saturación del sistema. El objetivo del trabajo es describir el perfil del demandante de urgencias hospitalarias y extrahospitalarias en Navarra y conocer los factores que motivan la utilización de los servicios de urgencias. Metodología. Estudio multicéntrico transversal. Se utilizó un cuestionario autoadministrado de respuestas múltiples. Se entrevistaron a 2.364 pacientes que acudieron a un servicio de urgencias hospitalario o extrahospitalario (excluidos las visitas domiciliarias) en Navarra, entre el 15 y el 21 de noviembre de 2007. Se recogen datos descriptivos del paciente, razones que le motivan a solicitar asistencia urgente agrupadas en 3 bloques (18 ítems) y sensación de gravedad (leve, moderada, grave) que otorga a su sintomatología. La asociación entre autopercepción de gravedad y acudir a hospital y las otras variables de estudio se analizó mediante regresión logística no condicional. Resultados. La atención extrahospitalaria es la más demandada (62,7%). Las razones principales para usar los servicios son necesidad (66,3%) y comodidad (40,7%). Existen diferencias estadísticamente significativas entre las demandas hospitalaria y extrahospitalaria. Quienes valoran su estado como leve (24,1%), acuden más a su servicio extrahospitalaria (OR:1,4; IC95%:1,1-1,9), su estado de salud habitual es bueno (OR:2,1; IC95%:1,3-3,2) y señalan razones de comodidad (OR:1,6; IC95%:1,3-2) como razones de demanda. Conclusiones. Los usuarios y los médicos deben participar en el debate para intentar incidir en el mal uso de los servicios sanitarios, tanto por exceso como por defecto.
Open Access
Trends in mortality from stroke in Latin America and the Caribbean, 1979-2015
(Ubiquity Press, 2022) Soto Venegas, Álvaro; Guillén Grima, Francisco; Morales Illanes, Gladys; Muñoz, Sergio; Aguinaga Ontoso, Inés; Vanegas, Jairo; Ciencias de la Salud; Osasun Zientziak
Background: stroke is the second largest single cause of death and disability in Latin America and the Caribbean (LAC). There have been large overall declines in stroke mortality rates in most LAC countries in recent decades. Objective: to analyze trends in mortality caused by stroke in LAC countries in the period 1979-2015. Methods: we extracted data for age-standardized stroke mortality rates per 100,000 in LAC for the period 1979-2015 from the World Health Organization Mortality Database. Joinpoint regression was used to analyze the trends and compute the annual percent change (APC) in LAC as a whole and by country. Analyses were conducted by gender, region and World Bank income classification. Results: mortality from stroke has decreased in LAC over the study period by an average APC of -1.9%. Most countries showed significant downward trends, with the sharpest decreases in Chile, Colombia and Uruguay. We recorded statistically significant decreases of -1.4% and -2.4% in mortality rates in men and women, respectively, in the whole LAC. Southern and high-income countries showed the steepest decreases. Conclusions: stroke mortality has decreased in LAC, in both sexes, especially in southern and high-income countries. Our results could serve as a reference for the development of primary prevention and acute management of stroke policies focused on countries with higher mortality.
Open Access
Being born in winter-spring and at around the time of an influenza pandemic are risk factors for the development of schizophrenia: the apna study in Navarre, Spain
(MDPI, 2021) Álvarez-Mon, Miguel Ángel; Guillén Aguinaga, Sara; Pereira-Sánchez, Víctor; Onambele, Luc; Al-Rahamneh, Moad J.; Brugos Larumbe, Antonio; Guillén Grima, Francisco; Ortuño, Felipe; Ciencias de la Salud; Osasun Zientziak
Background: we analyzed the relationship between the prevalence of schizophrenia and the season of birth and gestation during a period of an influenza pandemic. Methods: cross-sectional analysis of a prospective population-based cohort of 470,942 adults. We fitted multivariant logistic regression models to determine whether the season of birth and birth in an influenza-pandemic year (1957, 1968, 1977) was associated with schizophrenia. Results: 2077 subjects had been diagnosed with schizophrenia. Logistic regression identified a significantly greater prevalence of schizophrenia in men than in women (OR = 1.516, CI 95% = 1.388–1.665); in those born in the winter or spring than in those born in the summer or autumn (OR = 1.112, CI 95% = 1.020–1.212); and in those born in a period of an influenza pandemic (OR = 1.335, CI 95% = 1.199–1.486). The increase in risk was also significant when each influenza pandemic year was analyzed separately. However, neither month of birth nor season of birth, when each of the four were studied individually, were associated with a statistically significant increase in that risk. Conclusions: the winter–spring period and the influenza pandemics are independent risk factors for developing schizophrenia. This study contradicts many previous studies and thus revitalizes a locked debate in understanding the neurodevelopmental hypothesis of this disorder.
Open Access
Community-based health education led by women's groups significantly improved maternal health service utilization in southern Ethiopia: a cluster randomized controlled trial
(MDPI, 2024) Yoseph, Amanuel; Teklesilasie, Wondwosen ; Guillén Grima, Francisco; Astatkie, Ayalew; Ciencias de la Salud; Osasun Zientziak
Objective: This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. Methods: From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. Results: The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ2 = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ2 = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12-1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06¿1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ2 = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89-1.48). Conclusion: A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. Trial registration number: NCT05865873.
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.
Open Access
Valoración de la calidad metodológica y ética de los ensayos clínicos publicados en revistas de medicina de familia (2010-2013)
(Academia Nacional de Medicina de México, 2018) Castaño García, Alberto; Guillén Grima, Francisco; León Sanz, Pilar; Ciencias de la Salud; Osasun Zientziak
Evaluar algunas variables sobre la calidad metodológica y ética de los ensayos clínicos publicados en 10 revistas de medicina de familia. Métodos: Estudio descriptivo de calidad sobre 10 revistas de medicina de familia incluyendo ensayos clínicos en humanos publicados entre 2010 y 2013. Obtuvimos 141 ensayos clínicos y fueron excluidos 2447. Resultados: Ensayos clínicos controlados paralelos en el 92,9% (intervalo de confianza del 95% [IC 95%]: 92.0-93.9). Aleatorización enmascarada en el 72.3% (IC 95%: 71.7-73.1), descentralizada en el 51.8% (IC 95%: 51.4-52...4) y utilizando como control un tratamiento activo el 82.2% (IC 95%: 81.5-83.1). Consentimiento informado escrito en el 48.9% (IC 95%: 48.5-49.5) y no fue retirado en el 56.0% (IC 95%: 55.5-56.7). En 134 ensayos clínicos se contó con la aprobación por un comité ético de investigación clínica (CEIC), y en 117 no hubo conflicto de intereses. Se obtuvo un κ medio de 0,96 (IC 95%: 0.93-0.99). Conclusiones: Observamos, tras considerar las normas CONSORT, un aumento en algunas variables de calidad, como la aleatorización en-mascarada (19.6%) y la aprobación por un CEIC (75%), en los ensayos clínicos publicados en 10 revistas de medicina de familia (2010-2013).
Open Access
Effectiveness of copper as a preventive tool in health care facilities: a systematic review
(Elsevier, 2023) Aillón-García, Paula; Parga-Landa, Blanca; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Introduction: Hospital-acquired infections (HAIs) are a significant clinical and economic burden on health systems worldwide. Copper alloys have been certified by the US EPA as solid antimicrobial materials, but their effectiveness in reducing HAIs is not well established Objectives: This systematic review aimed to assess copper surfaces in situ efficacy in reducing health care’s microbial burden compared to control surfaces. Materials and Methods: A literature search was conducted using three electronic databases: Web of Science, PubMed, and Scopus, with the keywords “copper” and “surfaces” and “antimicrobial” and “antibacterial” and “infections.” Studies from 2010 to 2022 were included. The quality of the studies was independently screened and assessed using the Newcastle Ottawa Scale. Results: A total of 56 articles were screened, with 8 included in the review and 7, added from references. Two third of the studies report a significant reduction in the microbial burden on copper objects compared to control objects. The 2 studies with the highest scores on NOS evaluation indicated that using copper or copper alloys in healthcare settings can effectively decrease the number of bacterial contaminations on touch surfaces. Conclusions: The results suggest the potential effectiveness of copper as a preventive tool in healthcare facilities, but further studies and longer trials are needed to establish a relationship between copper and reduced nosocomial infections.
Open Access
Valoración de la repercusión del dolor sobre la productividad laboral: validación del cuestionario WPAI:Pain
(Gobierno de Navarra. Departamento de Salud, 2016) Varela, N.; Guillén Grima, Francisco; Pérez-Cajaraville, J. J.; Pérez Hernández, C.; Monedero, P.; Ciencias de la Salud; Osasun Zientziak
Fundamento. Los instrumentos de medida de salud son esenciales en la actividad clínica diaria. Sin embargo, es necesario un proceso de validación para poder certificar la validez y fiabilidad de los mismos. En la actualidad no existe ninguno que permita evaluar la repercusión del dolor en la productividad laboral de los pacientes. El objetivo de nuestro estudio es validar un cuestionario para evaluar las consecuencias del dolor en dicha productividad. Método. En base al Work Productivity and Activity Impairment Questionnaire – General Health hemos creado una versión modificada denominada WPAI: Pain con el fin obtener un cuestionario que pudiera medir las consecuencias del dolor en la productividad laboral. El estudio se realizó siguiendo las pautas habituales de validación de pruebas, omitiéndose las fases de redacción y validez de contenido ya que se modificaba un cuestionario existente. Resultados. Se obtuvieron 577 cuestionarios en dos hospitales universitarios españoles. Se comprobó la capacidad discriminante del cuestionario mediante prueba de U de Mann-Whitney. Se realizaron los test de fiabilidad obteniéndose un alfa de Cronbach de 0,896 con un test de dos mitades de Guttman de 0,921. Se comprobó la estabilidad con un test-retest estadísticamente significativo. La validez de constructo se estableció mediante correlación de Pearson comparando los resultados del cuestionario con el dolor en escala visual analógica, que resultó estadísticamente significativa para todos los valores. Conclusiones. El cuestionario WPAI: Pain es un instrumento de medida válido para determinar las consecuencias del dolor en la productividad laboral de los pacientes, siendo el único validado en español. Sin embargo, se requieren estudios de mayor envergadura para poder confirmar una validez universal.
Open Access
Prevalencia de actividad física y su relación con variables sociodemográficas y estilos de vida en la población de 18 a 65 años de Pamplona
(Ministerio de Sanidad, Servicios Sociales e Igualdad, 2005) Elizondo Armendáriz, José Javier; Guillén Grima, Francisco; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
Fundamento: los conocimientos actuales permiten considerar que existe una asociación de tipo causal entre el nivel de actividad física y la aparición de diversas enfermedades. A pesar de ello, la actividad física es una práctica poco arraigada en la población, que cada vez se está haciendo más sedentaria. El objetivo de este estudio es describir la prevalencia de sedentarismo en la población de Pamplona, así como conocer cuáles son los factores que más influyen en él. Métodos: se llevó a cabo un estudio transversal mediante encuesta postal en una muestra significativa de la población de Pamplona de 18 a 65 años. La encuesta utilizada incluía una evaluación de la actividad física realizada, basada en el cuestionario de actividad física de Paffenbarger. Se realizó un análisis bivariado y multivariado con aplicación de regresión logística. Resultados: un 76,6% de las mujeres tienen un estilo de vida sedentario, mientras que en los varones este porcentaje se reduce hasta un 56,7%. El sedentarismo se incrementa con la edad, existiendo hasta un 80,3% de varones sedentarios en el grupo de mayor edad, y un 86,3% entre las mujeres, respectivamente. Conclusiones: los factores sociodemográficos como sexo, edad, estudios, profesión y estado civil parecen ser determinantes del estilo de vida sedentario, mientras el consumo de tabaco y la existencia de sobrepeso y obesidad no lo son. Entre las personas jóvenes, las mujeres sin estudios universitarios y los varones casados y fumadores parecen ser poblaciones diana para la promoción de la actividad física.
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.