Adherence to treatment with sodium-glucose co-transporter protein type 2 inhibitors (SGLT2i) is essential for the successful treatment of type 2 diabetes. As SGLT2i induce glucosuria, the main study objective was to assess the potential relationship between glucosuria level and adherence to SGLT2i. The study used electronic health records of patients aged ≥45 years old that had urinalysis data. Glucosuria was classified as absent/normal (0 mg/dL), intermediate (1-1000 mg/dL), and evident (>1000 mg/dL). Renal function, expressed by estimated glomerular filtration rate and stage of chronic kidney disease (CKD), was also assessed. Adherence to SGLT2i was measured with the proportion of days covered in 6 months. Only 9.2% of samples showed evident glucosuria; of these, 87.5% belonged to patients treated with SGLT2i. Among these patients, glucosuria was mostly evident (78.9%). Absent glucosuria was more common in patients with CKD and in advanced KDIGO stages; therefore, in these patients glucosuria as adherence marker should be interpreted with caution.In patients treated with SGLT2i, absent glucosuria was detected in 4.5% of samples from patients with good adherence, 18.5% of samples from patients with intermediate adherence, and up to 38.5% of samples from patients with poor adherence (p <0.01). Absent glucosuria was also associated with higher blood uric acid level and lower hemoglobin and hematocrit. Absent glucosuria was more common in women and older patients. Absent glucosuria could be an easy biomarker of poor adherence in patients treated with SGLT2i in clinical practice. Adherence to treatment is the degree to which a patient takes their medication as prescribed. As poor adherence is associated with reduced efficacy of treatment,early detection of low adherence is important, especially in chronic diseases such as diabetes. However, measuring adherence in clinical practice can be difficult. The objective of the study was to assess glucose (sugar) in urine as a marker of poor adherence in patients with diabetes treated with SGLT2i, a class of antidiabetic drugs characterized by increasing glucose in urine. Examples of SGLT2i are canagliflozin, dapagliflozin, empagliflozin and ertugliflozin. Using electronic health records with urine analysis data, the researchers classified glucose in urine as absent (0 mg/dL), intermediate (1-1000 mg/dL), and evident (higher than 1000 mg/dL). Glucose was evident in 78.9% of urine samples, as expected because of the effect of SGLT2i of increasing glucose in urine. However, glucose was absent in a significant 9% of urine samples. Regarding the relationship between glucose in urine and adherence, glucose was absent in almost 40% of samples from patients with poor adherence. Furthermore, absent glucose in urine was more common in advanced stages of chronic kidney disease and therefore its value as an adherence marker should be interpreted with caution in these cases. Absent glucose in urine was also related to higher blood uric acid level and lower hemoglobin and hematocrit. The researchers concluded that glucose in urine could be an easy way to evaluate adherence in patients treated with SGLT2i in clinical practice.
Chronic Kidney Disease associated with Diabetes Mellitus (CKD-DM) is a prevalent condition with significant morbidity, mortality, and healthcare burden. Despite its relevance, its specific characteristics within the Spanish context have been scarcely described. To determine the prevalence, clinical phenotypes, and therapeutic management of CKD-DM according to KDIGO guidelines in a healthcare area in southern Spain. Observational, cross-sectional, and retrospective study based on SIDICAM records from July 2021 to June 2023 in the Campo de Gibraltar East Health Management Area. Diabetic patients (PDM) were identified and classified according to KDIGO 2024 criteria: estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Among the 8,732 PDM analyzed, 32.3% had CKD-DM (95% CI: 31.3%-33.2%), and 6.9% met criteria for nephrology-range CKD-DM. The predominant phenotype was eGFR <60mL/min/1.73 m2 (14.2%), followed by the combined phenotype (9.2%) and isolated albuminuria (8.9%). Prevalence was higher in women and increased with age and diabetes duration. SGLT2 inhibitors were used in 48% of patients with CKD-DM, rising to 60% among the youngest group. CKD-DM shows a high prevalence and phenotypic variability according to age, sex, and diabetes progression. This study highlights the need for personalized preventive and therapeutic strategies, as well as the crucial role that primary care must play in the early detection and management of CKD-DM.
Treatment for enteric parasites is a common practice in beef cattle, yet little data is known about the prevalence of nematode and trematode parasite infections in beef cattle in the western United States. Likewise, the data on the efficacy of deworming practices and the presence of anthelmintic resistance (AR) of these parasites in this region is sparse. The current study collected evidence for the presence of nematode and trematode parasites in 18 herds of young beef cattle grazing either dryland or irrigated pasture in northern California as well as on efficacy and evidence of AR in a subgroup of herds. We found variable levels of fecal egg counts (FEC) ranging from 6 to 322 for the arithmetic mean eggs per gram (EPG) in the tested cattle groups. There was no difference in the number of EPG between herds grazing dryland or irrigated pasture (P = 0.54). We did not find any evidence for liver flukes or lungworms in the tested cattle. There was evidence of AR to macrocyclic lactones in all eight herds where fecal egg count reduction tests (FECRT) were performed, however due to types and execution of treatment applications and sample sizes, these results need to be interpreted with caution. The most common genus of third stage larvae in coproculture testing before treatment was Cooperia (between 55% and 98% of larvae) as well as post treatment for those herds undergoing FECRT (between 50% and 96%). Ostertagia was the second most frequent genus of larvae found in coproculture testing making up between 0% and 27% of larvae before treatment and between 5% and 50% of larvae after treatment. Anthelmintic practices in beef herds in northern California and likely in a larger geographic area in the western United States need to be updated in order to continue effective use of the currently available drugs.
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of developing chronic kidney disease (CKD). CKD is defined by both a decline in glomerular filtration rate and the presence of albuminuria. Although the measurement of the urine albumin-to-creatinine ratio is recommended from the time of T2DM diagnosis and subsequently at least once a year, in clinical practice, this assessment is underutilized in many patients. The pathophysiology of diabetic kidney disease involves hemodynamic, metabolic, pro-inflammatory, and pro-fibrotic factors. Likewise, in cardio-reno-metabolic syndrome, excessive or dysfunctional adiposity plays a fundamental role, promoting the development of kidney disease, type 2 diabetes and cardiovascular disease. Therefore, its management requires a multifactorial approach that includes the use of renin-angiotensin-aldosterone system inhibitors (targeting hemodynamic factors), SGLT2 inhibitors (targeting both hemodynamic and metabolic factors), finerenone (with anti-inflammatory and anti-fibrotic effects), and GLP-1 receptor agonists with demonstrated renal benefits (targeting metabolic factors), with the aim of more effectively slowing CKD progression and reducing the risk of cardiovascular complications. In this review article, we propose strategies to facilitate the proper assessment and implementation of guideline-recommended treatment in patients with diabetes and albuminuria, presenting a ten-point framework to improve the comprehensive and collaborative management of these patients.
Anemia is a common comorbidity in patients with diabetes mellitus (DM), particularly in older adults. However, there is a lack of data on the prevalence and the characteristics of anemia in this population in Spain. To describe the prevalence and the characteristics of anemia in patients with DM aged 50 or older (PDM50) in a healthcare district in the province of Cádiz. A retrospective cross-sectional study was conducted that included outpatient's laboratory tests (OLT) performed over 30 months at PDM50. The prevalence of anemia was 29.9% (95% CI: 28.7%-31.1%), predominating in women (33.3% vs 26.7%; P < 0.01), in older people stratified by decades (61.7% in 9th decade vs 12% in 5th decade; P < 0.01), and in those with kidney disease (44.7% vs 28%; P < 0.01). Most cases were mild (68.3%), normocytic (78.7%), and hypochromic (52%). Similarly, moderate-to-severe anemia was more frequent in women (39% vs 23%), their prevalence increased with age (45% in the 9th decade vs 24% in the 5th decade), and with the progression of kidney damage, either measured by a decreased glomerular filtration rate (GFR) (49% in G4 vs 25% in G1), or the presence of albuminuria (P < 0.01). No association was found between DM control, based on glycated hemoglobin (HbA1c), and anemia in either sex (P = 0.887). This study describes a high prevalence of anemia in PDM50, particularly in women, in the most advantageous people and in the presence of kidney disease, even in early stages, highlighting the clinical importance of this coexistence.
Nephrotoxicity stands as one of the most limiting effects in the development and validation of new drugs. The kidney, among the organs evaluated in toxicity assessments, has a higher susceptibility, with nephrotoxic potential frequently evading detection until late in clinical trials. Traditional cell culture, which has been widely used for decades, does not recapitulate the structure and complexity of the native tissue, which can affect cell function, and the response to cytotoxins does not resemble what occurs in the kidney. In the current study, we aimed to address these challenges by creating in vitro kidney models that faithfully biomimic the dynamics of the renal proximal tubule, using the well-established RPTEC/TERT1 cell line. For doing so, two models were developed, one recreating tubule-like structures (2.5D model) and the other using microfluidic technology (kidney-on-a-chip). The 2.5D model allowed tubular structures to be generated in the absence of hydrogels, and the kidney-on-a-chip model allowed shear stress to be applied to the cell culture, which is a physiological stimulus in the renal tissue. After characterization of both models, different nephrotoxic compounds such as cisplatin, tacrolimus, and daunorubicin were used to study cell responses after treatment. The developed models in our study could be a valuable tool for pre-clinical nephrotoxic testing of drugs and new compounds.
In this article, we present the findings of a comprehensive longitudinal social network analysis conducted on Twitter across four consecutive election campaigns in Spain, spanning from 2015 to 2019. Our focus is on the discernible trend of increasing partisan and ideological homogeneity within interpersonal exchanges on this social media platform, alongside high levels of networking efficiency measured through average retweeting. This diachronic study allows us to observe how dynamics of party competition might contribute to perpetuating and strengthening network ideological and partisan homophily, creating 'epistemic bubbles' in Twitter, yet showing a greater resistance to transforming them into 'partisan echo-chambers.' Specifically, our analysis reveals that the rise of a new radical right-wing party (RRP), Vox, has heightened ideological homogeneity among users across the entire ideological spectrum. However, this process has not been uniform. While users aligned with mainstream political parties consistently share content that reinforces in-party affinity, resulting in highly efficient 'epistemic bubbles,' the emergence of the RRP has given rise to a distinct group of users associated with the most extreme partisan positions, characterized by a notable proportion of out-partisan hostility content, which has fostered the creation of low-efficient 'partisan echo-chambers.'
The aim of this study is to analyse the effect of pharmacological and non-pharmacological treatment on weight control in patients with diabetes and obesity. Epidemiological, descriptive, cross-sectional study. SITE: Primary care. In 11 health centres in Málaga and Cádiz during April and October 2022. 281 patients over 18 years old with type 2 diabetes and obesity are included. Socio-demographics, clinical, treatment and lifestyle habits variables were obtained from medical records and personal interview. Descriptive statistics were obtained for continuous variables. Statistical tests were performed based on the nature of the variables. Variables like marital status, level of education and occupation, and smoking habit, shows differences regarding the sex (p<0.05). 82.3% of those who received education lost weight, compared to 67.5% of lost weight who received no health education (p=0.004). GLP1 and SGLT2 were more commonly prescribed for women (p=0.048), and SGLT2 more commonly prescribed for men (p=0.047). Patients taking GLP1, SGLT2 or both, regardless of sex, weight loss during the study period was -3.1kg (SE: 0.60), while the loss of those who took other medications was -1.33kg (SE: 0.62). The mean difference was 1.75kg (p=0.046). In terms of weight loss, obese diabetics who took GLP1, SGLT2 or both were 2.5 times more likely to lose weight than those who did not. Healthy lifestyle choices are key to weight loss in obese diabetic patients. Analizar el efecto del tratamiento farmacológico y no farmacológico en el control del peso en pacientes diabéticos obesos. Estudio epidemiológico, descriptivo y transversal. Atención primaria: 11 centros de salud en Málaga y Cádiz durante abril y octubre de 2022. Fueron incluidos 281 pacientes mayores de 18 años con diabetes tipo 2 y obesidad. Se obtuvieron variables sociodemográficas, clínicas, de tratamiento y de hábitos de vida a partir de registros médicos de entrevistas personales. Se obtuvieron estadísticos descriptivos para variables continuas. Se realizaron pruebas estadísticas en función de la naturaleza de las variables. Variables como el estado civil, el nivel educativo, la ocupación y el hábito de fumar mostraron diferencias dependiendo del sexo (p < 0,05). El 82,3% de los que recibieron educación sobre salud perdieron peso en comparación con el 67,5% de los que perdieron peso y no la recibieron (p = 0,004). Los medicamentos GLP1 y SGLT2 se recetaron con mayor frecuencia a las mujeres (p = 0,048), mientras que los SGLT2 se prescribieron más en hombres (p = 0,047). Los pacientes que tomaron GLP1, SGLT2 o ambos, independientemente del sexo, perdieron 3,1 kg durante el estudio (EE: 0,60), mientras que aquellos que tomaron otros medicamentos perdieron 1,33 kg (EE: 0,62). La diferencia media fue de 1,75 kg (p = 0,046). Los diabéticos obesos que tomaron GLP1, SGLT2 o ambos tenían 2,5 veces más probabilidades de perder peso que aquellos que no los tomaron. Un estilo de vida saludable es fundamental para la pérdida de peso en pacientes diabéticos obesos.
It is unclear how engaging in physical activity after long periods of inactivity provides expected health benefits. To determine whether physically inactive primary care patients reduce their mortality risk by increasing physical activity, even in low doses. Prospective cohort of 3357 physically inactive patients attending 11 Spanish public primary healthcare centres. Change in physical activity was repeatedly measured during patients' participation in the 'Experimental Program for Physical Activity Promotion' clinical trial between 2003 and 2006, using the '7-day Physical Activity Recall'. Mortality to 31 December 2018 (312 deaths) was recorded from national statistics, and survival time from the end of the clinical trial analysed using proportional hazard models. After 46 191 person-years of follow-up, compared with individuals who remained physically inactive, the mortality rates of those who achieved the minimum recommendations of 150-300 min/week of moderate- or 75-150 min/week of vigorous-intensity exercise was reduced by 45% (adjusted hazard ratio [aHR] 0.55; 95% confidence interval [95% CI] = 0.41 to 0.74); those who did not meet these recommendations but increased physical activity in low doses, that is, 50 min/week of moderate physical activity, showed a 31% reduced mortality (aHR 0.69, 95% CI = 0.51 to 0.93); and, those who surpassed the recommendation saw a 49% reduction in mortality (aHR 0.51, 95% CI = 0.32 to 0.81). The inverse association between increased physical activity and mortality follows a continuous curvilinear dose-response relationship. Physically inactive primary care patients reduced their risk of mortality by increasing physical activity, even in doses below recommended levels. Greater reduction was achieved through meeting physical activity recommendations or adopting levels of physical activity higher than those recommended.
United States nephrology societies recommend changing from the CKD-EPI 2009 equation to the new CKD-EPI 2021 equation, which does not include the race coefficient, for calculating estimated glomerular filtration rate (eGFR). It is unknown how this change might affect the distribution of kidney disease in the predominantly Caucasian Spanish population. Two databases of adults from the province of Cádiz, DB-SIDICA (N=264,217) and DB-PANDEMIA (N=64,217), that had plasma creatinine measurements recorded between 2017 and 2021 were studied. Changes in eGFR and the consequent reclassification into different categories of the KDIGO 2012 classification resulting from substituting the CKD-EPI 2009 equation for the 2021 equation were calculated. Compared to the 2009 equation, CKD-EPI 2021 yielded a higher eGFR, with a median of 3.8mL/min/1.73m2 (IQR 2.98-4.48) in DB-SIDICA and 3.89mL/min/1.73m2 (IQR 3.05-4.55) in DB-PANDEMIA. The first consequence was that 15.3% of the total population in DB-SIDICA and 15.1% of the total population in DB-PANDEMIA were reclassified into a higher category of eGFR, as were 28.1% and 27.3%, respectively, of the population with CKD (G3-G5); no subjects were classified into the more severe category. The second consequence was that the prevalence of kidney disease decreased from 9% to 7.5% in both cohorts. Implementing the CKD-EPI 2021 equation in the Spanish population, which is predominantly Caucasian, would increase eGFR by a modest amount (greater in men and those who are older or have a higher GFR). A significant proportion of the population would be classified into a higher eGFR category, with a consequent decrease in the prevalence of kidney disease.
The TRI-POL project explores the triangle of interactive relationships between affective and ideological polarisation, political distrust, and the politics of party competition. In this project there are two complementary groups of datasets with individual-level survey data and digital trace data collected in five countries: Argentina, Chile, Italy, Portugal and Spain. These datasets are comprised of three waves carried out over a six-month period between late September 2021 and April 2022. In addition, the survey datasets include a series of experiments embedded in the different waves that examine social exposure, polarisation framing, and social sorting. The digital trace datasets include variables on individuals' behaviours and exposure to information received via digital media and social media. This data was collected using a combination of tracking technologies that the interviewees installed in their different devices. This digital trace data is matched with the individual-level survey data. These datasets are especially useful for researchers who wish to explore dynamics of polarisation, political attitudes, and political communication.
暂无摘要（点击查看详情）
Hospitalization for acute decompensation of heart failure (ADHF) is a frequent event associated with long‑term adverse effects. Prognosis is even worse if acute kidney injury (AKI) occurs during hospitalization. The study aimed to determine whether kidney damage biomarkers neutrophil gelatinase‑associatedlipocalin (NGAL), kidney injury molecule 1 (KIM‑1), and interleukin18 (IL‑18) might predict AKI and have prognostic value in ADHF. Serum NGAL on admission and urine NGAL, KIM‑1, and IL‑18 on discharge were determined in 187 ADHF patients enrolled in a prospective, observational, unblinded study. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. Patients were followedfor 12 months to record all‑cause mortality. A total of 22% patients died during the follow‑up, with 52.5% dying within 4 months after discharge. Serum NGAL (P <0.001), urine NGAL (P = 0.047), and urinary KIM‑1 (P = 0.014) levels were significantly higher in the deceased patients at discharge. After adjustment for estimated glomerular filtration rate (eGFR), only urinary KIM‑1 independently predicted mortality at month 4 (hazard ratio [HR], 3.166; 95% CI, 1.203-8.334; P = 0.020) and month 12 (HR, 1.969; 95% CI, 1.123-3.454; P = 0.018) in Cox regression models. In receiver operating characteristic (ROC) analysis urinary KIM‑1 (area under the ROC curve [AUC] = 0.830) outperformed other markers of renal function. The Kaplan-Meier survival analysis showed KIM‑1 predictive value as additive to that of AKI incidence and admission eGFR. Admission serum NGAL was higher in AKI patients (P ≤0.001) with a modest diagnostic performance (AUC = 0.667), below that of urea (AUC = 0.732), creatinine (AUC = 0.696), or cystatin C (AUC = 0.676). Discharge urinary KIM‑1 was a strong and independent predictor of mortality, particularly during the most vulnerable period shortly after hospitalization. Admission serum NGAL was inferior to conventional renal function parameters in predicting AKI during ADHF.
To determine the needs of elderly individuals living alone and with some degree of dependency for activities of daily live. We performed a cross-sectional descriptive study in an urban health center (San Andrés-Torcal in Málaga, Spain). Persons aged more than 65 years old who lived alone and had some degree of dependency were studied. The sample was composed of 64 elderly individuals, 58 women and 6 men. The mean age was 83.3 years (SD 4.13). Sixteen people (25%) were independent for daily living when aided by others, while 48 (75%) had one or more needs that were not covered. The most frequent nursing diagnoses were: impaired physical mobility in 58, risk of falls in 54, diversional activity deficit in 48, impaired urinary elimination in 38, and social isolation or deterioration in social interaction in 36. Fifty-six individuals had family. Half had no contact with neighbors, 12 (18.8%), did not receive visits, and 26 (40.6%) had nobody to whom they could tell their problems. Architectonic barriers to the house were identified in 48 individuals and access barriers to the home were found in 29. The total sample received a pension of between 301 and 600 euros. The persons evaluated showed numerous areas of dependency and there was a high proportion whose basic needs were not suitably covered. Because of the multiple and distinct problems identified, we believe that active screening should be performed in this vulnerable population. In addition, special attention should be paid to these individuals and the required help should be offered so that they have information and access to the available health and social resources.
To determine the influence of dysfunctional thoughts and their relationship on the burden of caregivers. Descriptive study conducted in the San Andrés Torcal Health Centre, Malaga, Spain, in 2010. A random sample was selected from dependent person caregivers of the centre. Those patients who were receiving palliative care and those cases where the care was less than 6 weeks were excluded.We used the Dysfunctional Thoughts Questionnaire (DTQ) and the short Zarit questionnaire was used on the caregivers. Sociodemographic variables of the caregiver and variables related to care (presence of support, duration of care, and if applicable, the type of help received by them), were collected. Sociodemographic variables of the patients, as well as the Barthel index and presence or absence of dementia were recorded. ANALYSIS USED: descriptive analysis, Pearson correlation coefficient to assess the association between quantitative variables and Kolmogorov-Smirnov test. The mean DTQ score was 49.94 (95% CI; 42.0 - 49.8). The burden measured by Zarit test and dysfunctional thoughts were positively associated (Pearson correlation coefficient 0.57, P<.001). Dysfunctional thoughts have a high impact on our population of caregivers and may be a contributing factor to the onset of fatigue in the caregiver role.There is a positive association between stress of caregivers and dysfunctional thoughts, and is more intensive in caregivers of patients without dementia.
The quality of life assessment means investigating how patients perceive their disease. Malnutrition-specific characteristics make patients more vulnerable, so it is important to know how these factors impact on patients' daily life. To assess the quality of life in malnourished patients who have had hospital admission, and to determine the relationship of the quality of life with age, body mass index, diagnosis of malnutrition, and dependency. Multicenter transversal descriptive study in 106 malnourished patients after hospital admission. The quality of life (SF-12 questionnaire), BMI, functional independency (Barthel index), morbidity, and a dietary intake evaluation were assessed. The relationship between variables was tested by using the Spearman correlation coefficient. The patients of the present study showed a SF-12 mean of 38.32 points. The age was significantly correlated with the SF-12 (r= -0.320, p= 0.001). The BMI was correlated with the SF-12 (r= 0.251, p= 0.011) and its mental component (r= 0.289, p= 0.03). It was also reported a significant correlation between the Barthel index and the SF-12 (r= 0.370, p< 0.001). The general health perception in malnourished patients who have had a hospital admission was lower than the Spanish mean. Moreover, the quality of life in these patients is significantly correlated with age, BMI and functional independency. Introducción: La evaluación de la calidad de vida significa investigar cómo el paciente percibe la propia enfermedad. Los pacientes con desnutrición presentan unas características especiales que les hacen más vulnerables, por lo que es importante conocer cómo les afectan estos factores en el desarrollo de su vida habitual. Objetivo: Analizar la valoración de la calidad de vida en personas con desnutrición que han estado ingresadas y su asociación con la edad, el índice de masa corporal, el tipo de diagnóstico de desnutrición, y el grado de dependencia. Método: Estudio descriptivo trasversal multicéntrico en 106 pacientes desnutridos hospitalizados. Se realizó una valoración de la calidad de vida (cuestionario SF-12), el IMC, la independencia funcional (índice de Barthel), los factores de morbilidad, y de la evaluación de la ingesta. La asociación entre las distintas variables se analizó mediante correlación no paramétrica de Spearman. Resultados: Los pacientes de este estudio presentaban una media en el SF-12 de 38,32 puntos. La edad se correlaciona de forma significativa con el SF-12 (r= -0,320, p= 0,001). El IMC se correlaciona tanto con el SF-12 (r= 0,251, p= 0,011) como con el componente mental (r= 0,289, p= 0,03). El índice de Barthel también mostró correlaciones estadísticamente significativas con el SF-12 (r= 0,370, p< 0,001). Conclusiones: La autopercepción de la salud en pacientes desnutridos que han tenido un ingreso hospitalario se encuentra por debajo de la media española; además esta calidad de vida se ve afectada por la edad, el IMC y la capacidad funcional del paciente.
To describe and compare the prevalence of mental disorders across primary care populations, and estimate their impact on quality of life. Cross-sectional multilevel analysis of a systematic sample of 2539 attendees to eight primary care centres in different regions of Spain, assessed with the WHO Composite International Diagnostic Interview (CIDI 1.1), the Short Form Health Survey (SF-36) quality of life questionnaire and the SF-6D utility index. The 12-month prevalence of any mental disorder was 23% (95% confidence interval: 21-24%), 10% had mood, 9% anxiety, 5% organic, 4% somatoform, and 1% alcohol use disorders, with a significant between-centre variability (P<0.001). People with mental disorders had one standard deviation lower mental quality of life than the general population. We estimated that 1831 quality-adjusted life-years (QALYs) are lost annually per 100,000 patients due to mental disorders, without considering mortality. Mood disorders have the worst impact with an annual loss of 1124 QALYs per 100,000 patients, excluding mortality (95% confidence interval: 912-1351). Prevalence rates were similar to those obtained in international studies using the same diagnostic instrument and, given the significant between-centre variability found, it is recommended that mental health statistics be considered at small area level. Mental disorders, and especially mood disorders, are associated with very poor quality of life and higher scores on disability indexes than other common chronic conditions.
To describe the frequency and types of near misses and the recovery strategies employed by nurses in primary health care. Insufficient data are available on the role of nurses in near miss events and related factors in primary health care. A prospective descriptive study was carried out at one Urban Primary Health Care Centre, within the Málaga-Guadalhorce Health District (Malaga, Spain), from January to December 2018. Four of the ten nurses volunteered to take part. The nurses recovered 185 near misses, prevailing administrative or communication-related errors, followed by medication-related errors. No near misses were reported on the centre's anonymous error information platform. A significant number of near misses occurred which could have been avoided with better communication among health care personnel. A striking finding is the failure to inform the health centre, which suggests that improvements in safety culture are needed. It is the responsibility and the duty of nursing management to be aware of the characteristics and frequency of near misses in primary health care, to implement strategies for improvement and to foster a culture in which the necessary information on actual or potential errors is supplied.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）