Rafael Herruzo

Nosocomial Infections in Spain: Results of Five Nationwide Serial Prevalence Surveys (EPINE Project, 1990 to 1994)

OBJECTIVE To determine trends in rates of nosocomial infections in Spanish hospitals. DESIGN Prospective prevalence studies, performed yearly from 1990 through 1994. SETTING A convenience sample of acute-care Spanish hospitals. PARTICIPANTS AND PATIENTS The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately. RESULTS The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P = .0001). Patients admitted to intensive-care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis. CONCLUSIONS The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicated that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.

Mortality attributable to cardiovascular risk factors in Spain

Objective: To present the current burden of mortality attributable to some of the main cardiovascular risk factors in adults in Spain.Methods: Mortality attributable to risk factors was calculated by combining their prevalence, the relative risks for death, and the number of deaths in Spain. Prevalence of hypertension (≥140/90 mmHg), tobacco smoking, excess weight (body mass index ≥25 kg/m2), and self-reported diabetes were based on representative samples of the Spanish population in the 1990s. The relative risks came from valid international studies.Results: About 14 000 total deaths (25% of all deaths) were attributable to hypertension in Spains middle-aged population. A quarter of them were cardiovascular deaths. About 56 000 deaths were attributable to tobacco use in adults ≥35 y (16% of all deaths). Two-thirds of them were deaths for: lung cancer (26.5%), chronic obstructive pulmonary disease (20.9%), coronary heart disease (12.8%), and stroke (9.2%). About 28 000 deaths (8.5% of all deaths) were attributable to excess weight in adults. Two-thirds of them were cardiovascular deaths. About 2800 cardiovascular deaths were attributable to diabetes in adults ≥35 y (6% of all cardiovascular deaths).Conclusions: Mortality attributable to the risk factors studied is a major avoidable public health problem in Spain. The results presented are only illustrative but clearly show that there is considerable scope for prevention.

Actividad física de tiempo libre en un país mediterráneo del sur de Europa: adherencia a las recomendaciones y factores asociados

Introduccion y objetivos. Examinar en adultos de la Comunidad de Madrid la adecuacion de la actividad fisica en tiempo libre (AFTL) a las recomendaciones e identificar factores asociados. Metodos. Encuesta telefonica a 12.037 personas, representativa de la poblacion de 18-64 anos de Madrid. La AFTL se calculo en MET-h/semana mediante un cuestionario de frecuencia y duracion de AFTL. Se comparo con la recomendacion de realizar actividad al menos moderada ? 150 min/semana, o vigorosa ? 60 min/semana. Los factores asociados al cumplimiento se identificaron mediante regresion logistica. Resultados. La media de AFTL fue 17,3 (intervalo de confianza [IC] del 95%, 16,9-17,7) MET-h/semana y un 28,8% (IC del 95%, 28%-29,7%) alcanzo la recomendacion. La AFTL recomendada fue mas frecuente en varones que en mujeres (odds ratio [OR] = 2,41; IC del 95%, 2,20-2,64). Comparando con los mas jovenes, la adherencia disminuyo gradualmente con la edad hasta los 60-64 anos, donde la OR fue 0,20 (IC del 95%, 0,15-0,25). Respecto a los sujetos sin estudios, los universitarios siguieron mas frecuentemente la recomendacion (OR = 2,28; IC del 95%, 1,82-2,87). Las personas obesas tuvieron menos probabilidad que los normopesos de realizar la AFTL recomendada (OR = 0,49; IC del 95%, 0,40-0,61). Las personas con actividad laboral de baja intensidad se adhirieron a la recomendacion con mas frecuencia que las de ocupacion sedentaria (OR = 1,21; IC del 95%, 1,10-1,34). Conclusiones. La mayoria de los adultos de Madrid no siguio la recomendacion de AFTL. La adherencia fue menor en mujeres, al aumentar la edad, con menor nivel de estudios y en obesos, mientras que fue mayor en personas con ocupaciones que requieren baja intensidad fisica.

Tendencias de actividad física en tiempo libre y en el trabajo en la Comunidad de Madrid, 1995-2008

INTRODUCTION AND OBJECTIVES Information on trends in physical activity is very scarce in Mediterranean countries, which have the highest sedentariness in Europe. This study describes recent trends in leisure time physical activity (LTPA) and at work in the Madrid region. METHODS The data were taken from representative annual surveys of population aged 18-64 years, between 1995-2008, 28,084 people participated. We calculated total energy, quantified in metabolic equivalent (MET-1 h per week), spent on LTPA and on light LTPA (<3 MET), moderate LTPA (3-6 MET) and vigorous LTPA (>6 MET). The annual change in LTPA was estimated by linear regression, and occupational activity by logistic regression, adjusting for age, gender and educational level. RESULTS The total amount of LTPA in MET-1 h per week declined by 19.8% (P<.001) between 1995-2008; for both genders, all age groups and educational levels, except for those with the lowest level of education. The adjusted annual change in MET-1 h per week was: -0.21 (P<.001) for total LTPA; -0.1 (P<.001) for light; -0.08 (P<.001) for moderate; and -0.03 (P=.192) for vigorous. This decline is reflected by a shift to the left of the LTPA distribution in the population. Occupational physical inactivity has increased in the general population (odds ratio for annual change=1.01; 95% confidence interval, 1-1.02); specially in women, young and middle aged, and intermediate educational level. CONCLUSIONS There has been a decline in LTPA, mainly in light and moderate activities, accompanied by greater occupational physical inactivity. This could have contributed to the increase in obesity in the Community of Madrid between 1995-2008.

Aplicación hospitalaria del SERVQHOS: factores asociados a la satisfacción e insatisfacción

Resumen Introduccion Los pacientes deben contribuir de manera decisiva en la definicion de lo deseable o indeseable de la atencion sanitaria. Para medir la satisfaccion existen muchos instrumentos. Nosotros hemos elegido el SERVQHOS, una adaptacion al ambito hospitalario espanol de la encuesta SERVQUAL (un reconocido instrumento para medir la calidad asistencial percibida en el ambito empresarial). Objetivos Detectar y analizar factores que contribuyen a la satisfaccion e insatisfaccion del paciente. Metodologia Estudio transversal realizado en el Hospital Universitario La Paz de Madrid que abarca el periodo entre el 15 y el 31 de octubre de 2001. Se empleo un cuestionario, que fue aplicado a una muestra de 580 pacientes dados de alta. Se realizo un analisis descriptivo, y para identificar factores asociados con la insatisfaccion, se efectuo un analisis de regresion logistica. Resultados La poblacion satisfecha correspondio al 90,6% de los pacientes, y la insatisfecha, al 9,4%. La puntuacion SERVQHOS global fue de 3,87 ± 0,30, y aplicando el factor de correccion usado por Hall y Dornan, fue de 0,71. Los factores relacionados con la insatisfaccion como resultado de la regresion logistica son: ser mujer, no recibir suficiente informacion, ingreso de forma programada, no haber tenido ingresos previos y el hecho de no recomendar el hospital. Una de las principales quejas de los pacientes fue la falta de confort de las habitaciones. Discusion La poblacion satisfecha dio una gran importancia al factor humano (calidad subjetiva) o, dicho segun los propios pacientes, a “la buena atencion recibida”. Por el contrario, la poblacion insatisfecha, poco numerosa, se quejo de los componentes de la calidad objetiva, como tiempos de espera, confort e informacion. Las caracteristicas sociodemograficas son factores no modificables, y por lo tanto no seria etico dar un trato asistencial en funcion de ellas. Pero si podemos actuar sobre factores como la informacion, los tiempos de espera y el confort.

Systolic vs diastolic blood pressure: community burden and impact on blood pressure staging

Systolic blood pressure (SBP) is a more frequent cardiovascular risk factor than diastolic blood pressure (DBP), and has a greater impact on blood pressure staging, though this can vary with age, sex and country. Therefore this paper compares SBP and DBP in terms of community burden and impact on blood pressure staging, among Spains middle-aged population. Data were drawn from a cross-sectional study on a representative sample of the Spanish population aged 35–64 years. Blood pressure was determined under standardised conditions, and was classified as per WHO-ISH and JNC-VI criteria. Prevalence of SBP ⩾140 mm Hg was 34.1%, and that of DBP ⩾90 mm Hg, 30.9%. A total of 12% of subjects had isolated systolic hypertension (ISH) and 8.7% had isolated diastolic hypertension (IDH). Of treated hypertensives, 31% had their SBP controlled and 34% their DBP controlled. Of subjects not undergoing antihypertensive drug therapy, 60.8% had congruent SBP and DBP levels, 22.5% were up-staged on the basis of their SBP, and 16.7% were up-staged on the basis of their DBP. SBP alone thus correctly classified JNC-VI staging in 83.3% of subjects vs 77.5% for DBP alone. It was solely among the population >50 years of age, in both sexes, that systolic proved more frequent than diastolic hypertension, ISH greater than IDH prevalence, SBP worse than DBP control, and the percentage of SBP higher than that of DBP up-staged subjects. SBP constitutes a greater community burden than does DBP, and has a greater impact on blood pressure staging in Spains middle-aged population. However, the differential impact of SBP and DBP upon blood pressure burden and staging is favourable to SBP only among subjects >50 years old. These findings are in accordance with recent guidelines on hypertension management.

A Multicentre and stratified study of the attitude of medical students towards organ donation in Spain

ABSTRACT Introduction: Medical students represent a new generation of medical thought, and if they have a favourable attitude towards organ donation this will greatly encourage its promotion. Objective: To analyse the attitude of medical students in Spanish universities towards the donation of their own organs and to determine the factors affecting this attitude. Material and Methods: Type of study: A sociological, interdisciplinary, multicentre, and observational study in Spain. Study population: Students studying a degree in medicine enrolled in Spain (n = 34,000). Sample size: A sample of 9598 students (confidence of 99% and precision of ±1%), stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ donation and transplantation (PCID-DTO RIOS) was self-administered and completed anonymously. Results: The questionnaire completion rate was 95.7% (n = 9.275). 80% were in favour of donation, 2% against and 18% were undecided. The following main variables were related to a favourable attitude: being of the female sex (Odds Ratio = 1.739); being in the sixth year of the degree (OR = 2.506); knowing a donor (OR = 1.346); having spoken about the subject with one’s family (OR = 2.132) and friends (OR = 1.333); having a family circle that is in favour, more specifically, having a father (OR = 1.841), mother (OR = 2.538) or partner in favour (OR = 2.192); being a blood donor (OR = 2.824); acceptance of the mutilation of the body if it were necessary (OR = 2.958); and being an atheist or an agnostic (OR = 1.766). Conclusions: Spanish medical students generally have a favourable attitude towards organ donation, although 20% are not in favour.

Leisure-Time Physical Activity in a Southern European Mediterranean Country: Adherence to Recommendations and Determining Factors

INTRODUCTION AND OBJECTIVES To determine whether adults in Madrid, Spain adhere to leisure-time physical activity (LTPA) recommendations and to identify factors associated with adherence. METHODS A telephone survey of 12,037 individuals, representative of the Madrid population aged 18-64 years, was conducted. The LTPA level was quantified in metabolic equivalent (MET) hours per week from answers to a questionnaire on the frequency and duration of LTPA. This level was compared with the recommendation to engage in at least moderate activity >or=150 min/week or vigorous activity >or=60 min/week. Factors associated with adherence to the recommendation were identified using logistic regression analysis. RESULTS The mean LTPA level was 17.3 MET-hours/ week (95% confidence interval [CI], 16.9-17.7 MET-hours/week) and 28.8% (95% CI, 28%-29.7%) adhered to the recommendation. The recommended level was achieved more frequently in men than women (odds ratio [OR]=2.41; 95% CI, 2.20-2.64). In comparison with younger individuals, adherence decreased gradually with age until 60-64 years, when the OR was 0.20 (95% CI, 0.15-0.25). Compared with less well-educated individuals, the university-educated were more likely to meet the recommendation (OR=2.28; 95% CI, 1.82-2.87). Obese individuals achieved it less frequently (OR=0.49; 95% CI, 0.40-0.61) than normal-weight individuals. Those whose job involved low-intensity physical activity achieved it more frequently than those with sedentary occupations (OR=1.21; 95% CI, 1.10-1.34). CONCLUSIONS The majority of adults in Madrid did not achieve the recommended LTPA level. Adherence was lower in women, older individuals, the less well-educated and the obese, while it was greater in those with a job involving low-intensity physical activity.

Blood Pressure Responses in Young Adults First Exposed to High Altitude for 12 Months at 3550 m

To determine the changes in blood pressure (BP) and related variables in sea-level young adults with chronic exposure to high altitude, a longitudinal study was performed in male army recruits (n = 346; age 17.9 +/- 0.1 yr; BMI, 22.5 +/- 0.3 kg/m(2)) first exposed to 3550-m altitude for 12 months. Fifty male recruits (age 17.8 +/- 0.6 and BMI 22.6 +/- 0.3 kg/m(2)) never exposed to altitude were used as controls. A sustained higher mean diastolic BP (DBP) (82.1 +/- 1.0 mmHg at month 3; 81.3 +/- 0.9 mmHg at month 12) was observed, compared to first exposure and the control group (p < 0.001). The BP values were always higher than those of the sea-level control group (systolic blood pressure (SBP) 109 +/- 2.3 and DBP 67.4 +/- 0.8; p < 0.001), and a large proportion of subjects steadily presented overoptimal values for either systolic BP (SBP) (64%) or DBP (77%) and hypertensive DBP values (40%). The higher DBP was associated with lower Sao(2) (OR = 0.919; p < 0.05). In addition, the acute mountain sickness (AMS) score showed a slight decrease during re-exposure (3.9 +/- 0.3 vs.3.4 +/- 0.3; p < 0.001) and an inverse association to the before-descending Sao(2) at month 3 (OR = 0.906, p < 0.01). These data suggest that BP stabilization can take longer than currently thought and that each parameter has a different profile of change. Further, a sustained high DBP should be a matter of epidemiological concern and emphasizes the need for BP monitoring among young lowlanders exposed to high altitude.

Self-rated health according to amount, intensity and duration of leisure time physical activity

OBJECTIVE To examine the dose-response relationship between leisure time physical activity (LTPA) and self-rated health. METHODS A survey (n=18,058) representative of the population aged 18-64years of Madrid (Spain) conducted between 2000 and 2008. A questionnaire on the frequency and duration of numerous activities was used to assess the total amount, the intensity, and the duration of LTPA. Self-rated health was classified as optimal or sub-optimal (fair/bad/very bad). Analyses were performed using logistic regression. RESULTS Compared with no LTPA, active people in the lowest quintile for total amount of LTPA showed an odds ratio (OR) of sub-optimal health of 0.69; a linear dose-response relationship (p<0.001) was observed, with the OR gradually decreasing to 0.49 in the highest quintile of LTPA. There was an inverse gradient for LTPA intensity adjusted for energy expenditure, so that the OR of sub-optimal health was 0.69 for light LTPA, 0.60 for moderate, and 0.48 for vigorous (p linear trend <0.001). For the same duration, the frequency of optimal health increases with the intensity of LTPA. CONCLUSIONS The total amount of LTPA shows a graded and continuous association with better self-rated health. The benefits of LTPA on self-rated health increase with the intensity of the activity.