Autonomous Community Of Madrid Research Articles

Spatial disparities in incidence of COVID-19 in relation to economic and socio-demographic factors in the Autonomous Community of Madrid, Spain

This article models the relationship between the incidence of COVID-19 and several socioeconomic factors during the second period of epidemic (22 June 2020 to 06 December 2020) in the Autonomous Community of Madrid, Spain. Data collected from Basic Health Zones (BHZs) is adjusted using the random forest method, which proves very appropriate for capturing non-linear relationships and obtaining accurate and robust predictions. The results show that the impact of the examined socio-economic variables on rates of incidence of COVID-19 was not uniform, and that levels of mean income by neighborhood exerted stronger influence than population density, proportion of the Spanish population, mean age of the population or average household size. A complex spatial pattern emerges from the combination of impacts, reflecting the relative weights of the different factors in terms of intensity of the pandemic. This information may be considered strategic for the effective future management of health resources.

Anti-Trafficking Professionals and Institutionalized Violence in Spain: An Exploratory Study

In recent decades, an anti-trafficking legislative and policy framework has been developed in Spain, coupled with the funding of initiatives related to the protection of trafficked persons, especially women, largely carried out by faith-based and secular organizations. Using 25 interviews conducted with people employed in programmes targeting trafficked women in the Autonomous Community of Madrid, this article provides deeper exploration of this under-studied subject with a view to gaining a better understanding of the work experiences of professionals involved in these initiatives, with special attention paid to the challenges they face in enacting anti-trafficking activities while avoiding producing violence on assisted persons. The experiences of these professionals highlight that the neoliberal outsourcing of services to non-governmental organizations nevertheless contributes towards making anti-trafficking an apparatus in which violence materializes and reproduces. Significantly, this violence involves not only the people who are being assisted as trafficking victims but also some anti-trafficking professionals.

Prevalence of Leber hereditary optic neuropathy in the Community of Madrid (Spain), estimation with a capture-recapture method

BackgroundLeber hereditary optic neuropathy (LHON) typically presents in young adults as bilateral painless subacute visual loss. Prevalence data are scarce. The aim of this study was to examine the validity of different ascertainment sources used in population-based rare diseases registries to detect cases, and to explore the impact of a capture-recapture method in the estimation of the prevalence of LHON in the Autonomous Community of Madrid (ACM) in 2022.MethodsDescriptive cross-sectional population-based study. Potential LHON cases were detected by automatic capture from the healthcare information sources usually explored for the Regional Registry for Rare Diseases (SIERMA). Ophthalmologists provided data from their clinical registry. Positive predictive values (PPV) and sensitivity with 95% confidence intervals (CI) were estimated. Global and by sex prevalences were calculated with confimed cases and with those estimated by the capture-recapture method.ResultsA total of 102 potential LHON cases were captured from healthcare information sources, 25 of them (24.5%) finally were confirmed after revision, with an overall PPV of 24.5% (95%CI 17.2–33.7). By source, the electronic clinical records of primary care had the highest PPV (51.2, 95%CI 36.7–65.4). The ophthalmologists clinical registry provided 22 cases, 12 of them not detected in the automatic capture sources. The clinical registry reached a sensitivity of 59.5% (95%CI 43.5–73.6) and the combination of automatic capture sources reached a 67.6% (95%CI: 51.5–80.4). The total confirmed cases were 37, with a mean age of 48.9 years, and a men: women ratio of 2.4:1. Genetic information was recovered in 27 cases, with the m.3460 mutation being the most frequent (12 cases). The global prevalence was 0.55 cases/100,000 inhabitants (95%CI 0.40–0.75), and with the capture-recapture method reached 0.79 cases/100,000 (95%CI 0.60–1.03), a 43.6% higher, 1.15 cases/100,000 (95%CI 0.83–1.58) in men and 0.43 cases/100,000 (95%CI 0.26–0.70) in women.ConclusionsThe prevalence of LHON estimated in the ACM was lower than in other European countries. Population-based registries of rare diseases require the incorporation of confirmed cases provided by clinicians to asure the best completeness of data. The use of more specific coding for rare diseases in healthcare information systems would facilitate the detection of cases. Further epidemiologic studies are needed to assess potential factors that may influence the penetrance of LHON.

Clinical experience with once-monthly risperidone ISM in a mental health center. A retrospective study.

IntroductionLong-acting injectable antipsychotics have undergone a great development in recent years, becoming useful tools to facilitate therapeutic adherence. Once-monthly risperidone ISM is a new way of treatment which has been commercialized in Spain since September 2022.ObjectivesIn this study we will analyze our clinical experience with this treatment, especially in terms of tolerance and efficacy, during its first year of widespread use.MethodsLongitudinal retrospective study of monhtly risperidone users in a mental health center in the Autonomous Community of Madrid (Spain), between September 2022 and September 2023.A sample of 13 patients was selected, collecting both sociodemographic (age, gender) and clinical variables (diagnosis, dose, time elapsed, number of hospital readmissions, adverse effects and monotherapy or combined use). A descriptive analysis of the collected data was then carried out.ResultsMonthly risperidone was used in 13 patients: 15% (n=2) were women, and 85% (n=11) were male. The mean age of the patients was 43.6 years. The most frequent diganosis of these patients was “psychotic disorders” (84,6%, n= 11), with other diagnoses such as schizoaffective disorder (7,7%, n=1) and obsessive compulsive disorder (7,7%, n=1).The doses used of risperidone were 100mg every month in 61,5% of patients (n=8) and 75mg in 38,5% of patients (n=5). The mean time since the first administration was 4.35 months. Concerning monotherapy, 84,6% (n=11) of patients on monthly risperidone were on antipsychotic monotherapy, while 15,4% (n=2) required more than one antipsychotic. Among the switches made to monthly risperidone, 69,2% (n=9) were previously treated with oral risperidone, 15,4% (n=2) were treated with once-biweekly risperidone long-acting injectable, 7,9% (n=1) with oral paliperidone and 7,9% with aripiprazole monthly injectable.During the study period, hospital readmissions for psychiatric descompensations occurred in one patient (7,9%, n=1), while the rest of the patients (92,1%, n=12) did not present decompensations that required psychiatric admission.Moderate or severe effects occurred in one patient (7,9%, n=1), in the form of acute dystonia, which led to the interruption of injectable treatment. The rest of the patients (92,1%, n=12)) did not present severe adverse effects. Minor adverse effects appeared in 3 patients (25%); these adverse effects were already present in the previous treatment with oral risperidone and did not condition the suspension of the treatment.ConclusionsIn the sample analyzed, once-monthly Risperidone ISM had reasonable tolerance levels. Also, it´s shown to be effective in preventing psychotic decompensations and hospital admissions.Therefore, this new injectable of monthly risperidone represents a therapeutic alternative to consider in order to guarantee therapeutic adherence and improve the quality of life of patients with psychotic symptoms.Disclosure of InterestNone Declared

Potentially inappropriate prescriptions and potential prescription omissions in older people living with HIV.

This study aimed to determine the prevalence of potentially inappropriate prescriptions (PIPs) and potential prescription omissions (PPOs) in a Spanish cohort of people living with HIV (PLWH) aged ≥65 years and to identify risk factors for the presence of PIPs and PPOs. This retrospective cross-sectional study was conducted across 10 public hospitals in the Autonomous Community of Madrid, Spain. Clinical and demographic data were cross-checked against hospital and community pharmacy dispensation registries. PIPs and PPOs were assessed using the American Geriatrics Society (AGS)/Beers and Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. Risk factors for PIPs and PPOs and agreement between AGS/Beers and STOPP/START criteria were statistically analysed. This study included 313 PLWH (median age 72 years), of whom 80.5% were men. PIP prevalence rates were 29.4% and 44.4% based on the AGS/Beers and STOPP criteria, respectively. The concordance between AGS/Beers and STOPP criteria was moderate. Benzodiazepines and proton pump inhibitors were the chronic comedications most commonly involved in PIPs. PPOs were observed in 61.4% of the patients. The leading omissions were insufficient influenza and pneumococcal vaccine coverage and inadequate bone health-related treatments. The number of chronic comedications, female sex, neuropsychiatric disorders, and cancer diagnosis were risk factors for PIPs, whereas osteopenia and osteoporosis were risk factors for PPOs. A high prevalence of PIPs and PPOs was observed in our cohort of older PLWH. These findings emphasize the importance of comprehensive medication reviews in this population to reduce inappropriate medication use and address their specific and underserved therapeutic needs.

Investigating Local Patterns of Mumps Virus Circulation, Using a Combination of Molecular Tools.

Mumps is a vaccine-preventable disease caused by the mumps virus (MuV). However, MuV has re-emerged in many countries with high vaccine coverage. The World Health Organization (WHO) recommends molecular surveillance based on sequencing of the small hydrophobic (SH) gene. Additionally, the combined use of SH and non-coding regions (NCR) has been described in different studies, proving to be a useful complement marker to discriminate general patterns of circulation at national and international levels. The aim of this work is to test local-level usefulness of the combination of SH and MF-NCR sequencing in tracing hidden transmission clusters and chains during the last epidemic wave (2015-2020) in Spain. A database with 903 cases from the Autonomous Community of Madrid was generated by the integration of microbiological and epidemiological data. Of these, 453 representative cases were genotyped. Eight different SH variants and thirty-four SH haplotypes were detected. Local MuV circulation showed the same temporal pattern previously described at a national level. Only two of the thirteen previously identified outbreaks were caused by more than one variant/haplotype. Geographical representation of SH variants allowed the identification of several previously undetected clusters, which were analysed phylogenetically by the combination of SH and MF-NCR, in a total of 90 cases. MF-NCR was not able to improve the discrimination of geographical clusters based on SH sequencing, showing limited resolution for outbreak investigations.

University teaching skills in ICT and disability. The case of the Autonomous Community of Madrid

AbstractTeachers must be prepared to serve all learners, regardless of their abilities or needs in this information and communication society. This implies developing the necessary competences to provide inclusive education to all students. The purpose of this study was to investigate the opinion of university teachers in the Autonomous Community of Madrid on their training in the use of technologies to support students with disabilities. To carry out this research, a descriptive approach combining both quantitative and qualitative methods was used. The final sample consisted of 106 university teachers (information collected through questionnaires) and 8 professionals from ICT Production Resource Centres and Services for People with Disabilities in the respective universities (information collected through interviews). Two data collection instruments were used: an ad-hoc questionnaire as a data collection instrument, and a semi-structured interview. The results of the study showed that university teachers have a low level of competence in the use of information and communication technologies (ICT) to support students with disabilities. The lack of teacher training negatively affects the inclusion process in university education institutions. Higher education institutions need to promote the training of teachers in the use of technologies to cater for diversity.

Degree of technological implementation in intravenous chemotherapy management in hospitals of the Autonomous Community of Madrid

ObjectiveTo understand the degree of technological implementation in the processes of preparation and administration of cytostatics drugs that is available in those hospitals of the Autonomous Community of Madrid where intravenous chemotherapy is prepared. MethodA descriptive observational study through the completion of a survey targeted to the staff responsible for the preparation of this type of treatments. ResultsThe degree of implementation of assisted electronic prescription is high, there is a medium degree in the case of bar code reading technology, and low in terms of vial re-labelling and gravimetric and voice control for preparation. ConclusionsThere is a large room for improvement regarding traceability in the process of preparation and administration of intravenous chemotherapy.

Centralization of the methadone maintenance plan in a hospital pharmacy department in the Community of Madrid

In February 2018, Resolution 189/2018 was published in the Autonomous Community of Madrid with the objective of centralizing the procedure for the acquisition, preparation, distribution, and dispensing of methadone to Centres for the Comprehensive Care of Drug Addiction Patients within the Madrid Health Service under the responsibility of a Hospital Pharmacy Service.The Hospital Pharmacy Service began this activity in March 2018. This is the first time that the comprehensive management of a methadone maintenance plan has been centralized in an Hospital Pharmacy Service for the care of drug-dependent patients in the Autonomous Community of Madrid.At the beginning of the Project, the previous workflow was analysed, the pharmaceutical laboratory was adapted, and the methadone acquisition procedure was designed. A communication channel with the Centres for the Comprehensive Care of Drug Addiction Patients was implemented and application forms were designed. Corresponding control procedures were established given that the medication under consideration was a narcotic.Standard procedures for the acquisition of methadone, of containers for personalized dosing in Centres for the Comprehensive Care of Drug Addiction Patients, and transport routes were designed and contracted out through public tender in compliance with the Public Administration Contract Law. A tender has also been awarded for the implementation of a computerized management system and automated dispensing systems, which are currently undergoing installation.The pharmacotherapeutic protocol of the Methadone Maintenance Plan of the Autonomous Community of Madrid is also being updated.Over 18 months, 5,300 L of methadone solution have been prepared and 2,844 individual prescriptions have been dispensed.High levels of perceived satisfaction were reported via a questionnaire administered to the Centre for the Comprehensive Care of Drug Addiction Patients staff. The response rate was 92%. Overall satisfaction was very satisfied/quite satisfied (91%) and satisfied (9%). These results highlight the high level of satisfaction (quite satisfied or very satisfied: 81.8%) with the effectiveness and speed of resolution of incidents by the Hospital Pharmacy Service staff.This process incorporates the knowledge and experience of hospital pharmacists into this healthcare field, as well as taking advantage of existing resources, facilities, and procedures. All these aspects lead to an efficient, effective, and safe approach to this clinical-care activity and enable a change in the pharmacotherapeutic health care model for opioid-dependent patients.

Hospital pharmacist experience in a multidisciplinary team in special care settings

The COVID-19 pandemic is placing huge strain on health systems and professionals. Emergency departments and their pharmacy services have been the first to face this challenge before any other pharmacy units. This article provides a description of the experience of two public hospitals located in the Autonomous Community of Madrid, Spain.Team working and reciprocal trust have made it possible to meet the unprecedented demand for health services and has facilitated rapid decision making. Strategies have been developed to guarantee the availability, distribution and safe use of medications. Other strategies have included favoring communication within Emergency Departments pharmacy services, and between these services and Emergency Departments during the pandemic.Multidisciplinary cooperation and information sharing have traditionally formed the base for efficient and quality work, along with solid technologies that guarantee a safe use of medications. The crucial role of information and communication technologies during the pandemic may give rise to a new model of pharmaceutical care, which should not replace face-to-face Emergency Department pharmacist support and advice. Promoting the re-humanization of healthcare and pharmacy services is essential. An adequate technical training and the development of abilities such as flexibility, planning and coordination skills, and an assertive communication and management of emotions will be key to the successful management of unimaginable settings in the future.

Pharmacy Department management and organization

The WHO declared the SARS- CoV-2 outbreak a pandemic in March 11, 2020. Spain has been the third country with the highest number of reported cases of COVID-19. In the face of the pandemic, the authorities of the Autonomous Community of Madrid led an unprecedented transformation of hospital services by increasing the number of beds available, setting up temporary field hospitals in fairgrounds, and transforming hotels into support centers for patients with mild symptoms of COVID-19.In the light that this crisis will continue to be a real threat for the years to come, our hospital pharmacies need to be better prepared for similar outbreaks in the future.During the COVID-19 pandemic, the Department of Hospital Pharmacy of Hospital General Universitario Gregorio Maranon has faced four challenges: an exponential increase in the demand for resources, constant changes to therapeutic protocols and approaches, regulatory changes, and a dramatic impact on hospital staff (strain on human resources and psychological impact).This article is aimed at describing the main organizational changes implemented to the Department of Hospital Pharmacy of Hospital GU Gregorio Maranon and its relationship with other hospital pharmacies of the Community of Madrid. An account is provided of the strategies to be adopted for reorganizing a Department of Hospital Pharmacy and achieve a safe and effective use of medications. Strategies range from the creation of integral hospital task groups (COVID-crisis task group, protocolization task group, research task group) to the adaptation of the internal organization of the Department of Hospital Pharmacy, which encompasses aspects related to management and leadership; a communication plan (internal and external); staff management, and the reorganization and adaptation of processes.People, patients and professionals are at the core of these strategies. This paper is a reflection on key factors of “humanization in COVID times”

Dental injury offenses and compensation imposed by Spanish courts, before and during Covid-19. A cross-sectional study

Injuries to the dentofacial region caused by third parties can affect physiological, sensory and esthetic functions with legal repercussions. The personal and social circumstances generated by Covid-19 and the governmental measures taken to control it, have increased the risk factors for violence and with it, the resulting injury rate. The aim of the present investigation was to compare the amount of civil liability for dental injury crimes agreed by Spanish courts, in certain Autonomous Communities, before and during the pandemic situation caused by Covid-19. For this purpose, a analytic cross-sectional study was carried out by analyzing sentences from the database of the Judicial Documentation Center. A comparison of means (one-way ANOVA) was used on the amount of compensation between the different years, and between the Autonomous Communities of Madrid, Catalonia Cataluña, Andalusia, the Canary Islands and the Valencian Community. It was observed that the year 2020 stood out for the increase in the number of cases of dental injury offenses. For its part, the Autonomous Community of Andalusia showed the highest amount of compensation during the pandemic, although the highest number of cases corresponded to the Community of Madrid. The statistical analysis yielded a probability of more than 0.05, which eliminated the possibility of significant differences in each of the comparisons.

Factors associated to influenza vaccination among hospital’s healthcare workers in the Autonomous Community of Madrid, Spain 2021–2022

Influenza vaccination (IV) aims primarily to protect high-risk groups against severe influenza-associated disease and death. It is recommended in Spain for high-risk groups, including Healthcare workers (HCWs). However, vaccination uptake has been consistently below desirable levels. The objective of this study were to evaluate influenza vaccination coverage using data from the regional vaccination registry, during 2021–2022 season, among HCWs in public hospitals in Autonomous Community of Madrid (CAM) and to explore factors associated with influenza vaccination. We conducted a cross-sectional study using administrative data retrieved from the Regional Department of Health data repositories. A multilevel logistic regression model was designed to estimate Level 1 (individual) and Level 2 (contextual) variables that are associated with HCẂs vaccination. The study population was HCWs from 25 public hospitals in CAM who were active during the period of the influenza 2021–2022 vaccination campaign. The global influenza vaccination coverage (IVC) was 52.1 %. All study Level 1 variables were significantly associated with vaccine uptake. Greater IVC is associated with individual characteristics: female (OR1.14; 95 %CI 1.09–1.19), older age 59–69 years old (OR1.72; 95 %CI 1.60–1.84), born in Spain, medical staff, more than one high-risk condition (OR1.24; 95 %CI 1.10–1.40; respectively) and vaccinated in two previous campaigns (OR25.64; 95 %CI 24.27–27.09). IVC was highest among HCWs celiac disease (65.5 %) followed by diabetes mellitus (65.1 %) and chronic inflammatory disease (64.3 %). The hospital where the study subject worked also showed an effect on the vaccination uptake, although Level 2 variable (hospital complexity) was not positively associated. IVC in HCWs remains suboptimal. These findings may prove useful to tailor strategies to reach specific groups. It is recommended to delve into the identification of factors associated with the HCWs workplace that may have a positive impact on IV.

Diagnosis of the ecological condition of the drove road network in the Autonomous Community of Madrid (central Spain)

ContextDrove roads are landscape corridors traditionally used for livestock movement in many regions of the world, including Spain, where they cover about 0.8% of the land. They have ecological importance due to their role in connectivity, seed dispersal, soil preservation, habitat and biodiversity conservation, and the provision of ecosystem services. Drove roads are experiencing deterioration due to the abandonment of extensive grazing and transhumance.ObjectivesWe aim to characterize the conservation status and main predictors of deterioration of the drove roads in the Community of Madrid, a region in Spain with a high presence of these corridors.MethodsWe considered all the network of the region, with the main analyses based on a sample of 160 segments of 200 m-long, which were evaluated using GIS and fieldwork.ResultsNearly one third of the network surface is occupied by crops, communication infrastructure, and urban or industrial surfaces. Natural habitats make up 60% of the network and are affected by soil degradation and grazing abandonment. Landscape matrix was the main predictor of drove road status, with urban and cropland matrices leading to a reduction in spatial integrity and availability for natural habitats. Grazing was most preserved in grassland matrices. Eco-district, drove road width, and distance to city center also had influence on conservation status.ConclusionsDespite their concerning state, the network is restorable in many areas of the region. Restoration should focus on intensified and simplified landscapes, where the network plays a more decisive role, and should consider the reintroduction of livestock.

Prevalence of fosA3 Gene in Fosfomycin-Resistant Proteus mirabilis in the Autonomous Community of Madrid (Spain) and Characterization of Two Positive Strains.

Plasmid-mediated resistance to fosfomycin has been seldom described in Proteus mirabilis. We report two strains harboring fosA3 gene. Whole-genome sequencing revealed a plasmid that encoded fosA3 gene flanked by two insertion sequence (IS)26 mobile elements. Both strains also produced the blaCTX-M-65 gene that was located in the same plasmid. The sequence detected was IS1182-blaCTX-M-65-orf1-orf2-IS26-IS26-fosA3-orf1-orf2-orf3-IS26. The importance of this transposon lies in its ability to spread in Enterobacterales, therefore, epidemiological surveillance should be carried out.

Identification and assessment of green infrastructure in the Community of Madrid

The recently approved Spanish Green Infrastructure (GI) Strategy obliges each autonomous community to identify and evaluate its own GI. This paper identifies and assesses the GI in the Community of Madrid at regional scale. This entailed, firstly, the identification of GI Principal Areas (GIPAS). This was followed by a spatial assessment of GI on the basis of three indicators: the Contribution to Ecosystem Services, the Combined Biodiversity Index and the Accessibility Index. After that, the correlations between GI assessment values and socioeconomic indicators were explored. The highest GI assessment values were located around the Sistema Central mountain range, and the lowest were in the Metropolitan Area and Henares Corridor. Finally, significant negative correlations were observed between the GI assessment values, population density and gross per capita income. The results of this study could provide useful support for the planning and decision-making required for the spatial definition of GI in the autonomous community of Madrid.

The Impact of COVID-19 on Nursing Homes: Study Design and Population Description.

Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.

Situation of Physiotherapy Clinics in the Community of Madrid in Relation to the Concept of Sustainability: A Survey Study

Introduction: Nowadays, it is increasingly urgent to regulate the use of the natural resources of our planet. From the field of physiotherapy, it is necessary to address this issue to ensure that our centers comply as much as possible with the Sustainable Development Goals (SDGs). Objective: To analyze the current situation in physiotherapy clinics in the Community of Madrid so as to identify whether their managers are aware of the concept of sustainability and its levels of application. Material and Methods: A survey study was carried out with the collaboration of 52 physiotherapy clinics in the Community of Madrid (Spain) to collect relevant data on sustainability. The questions were designed by experts in physiotherapy and sustainability with the aim of obtaining as much information as possible, analyzing the knowledge of sustainability and part of the goals established in the 2030 agenda. The procedures were conducted following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and checklist, in addition to following the Declaration of Helsinki. The study was approved by the Local Ethics Committee of the European University of Madrid, Madrid, Spain (CIPI/22.016). Results: A total of 35 questions were answered by 52 physiotherapy clinics in the Autonomous Community of Madrid (Spain) that completed the survey. In addition to the results of each question related to the concept of sustainability, significant differences were observed in the proportion of emotions detected with the NRC dictionary in the question about how waste is removed from the center (p = 0.002 and 0.008, respectively) with a higher proportion of positive feelings with emotions of joy, anticipation, confidence and surprise expressed by participants from clinics of less than 90 m2, while in those from clinics of more than 90 m2, negative feelings predominated with emotions of disgust, fear or sadness; in both cases, the effect of size was large and significant. Conclusions: Most of the physiotherapy clinics in the Community of Madrid that participated in the study are aware of the concept of sustainability. However, in practice, they do not sufficiently apply sustainability protocols in their clinics.

Prevalence of Chronic Obstructive Pulmonary Disease in an Urban Area. Changes in COPD Ten Years on.

PurposeThe prevalence of Chronic obstructive pulmonary disease (COPD) in Spain has been evaluated in the last ten years by EPISCAN in 2007 and EPISCAN II in 2017. This study describes changes in the prevalence of COPD in an urban region of Spain in the last 10 years, its risk factors and underdiagnosis.Patients and MethodsParticipants from the Autonomous Community of Madrid (Spain) were selected from both studies up to the age of 80 years. A descriptive analysis of their sociodemographic and clinical characteristics, as well as by gender, was conducted. COPD was defined by a post-bronchodilator ratio <0.70.ResultsThe prevalence of COPD in the Autonomous Community of Madrid increased non-significantly from 11.0% (95% CI: 8.9–13.5%) to 12.1% (95% CI: 9.6–15.1, p=0.612). However, the prevalence by gender showed an increase in women (5.6% to 14.7%, p<0.001) and a decrease in men (17.6% to 9.8%, p=0.08). Underdiagnosis was reduced from 81.0% to 67.9% (p=0.006), although with greater underdiagnosis in women (86.4% in EPISCAN and 100% in EPISCAN II). Smoking was higher in men than in women in EPISCAN (31.2% vs 23.0%, p<0.01) but with no differences by gender in EPISCAN II (25.5% men vs 26.0% women, p=0.146). Age, smoking, low BMI, and a sedentary lifestyle were consistently associated with COPD.ConclusionIn 10 years in Madrid, there have been no changes in the global prevalence of COPD, but there have been important changes in women, with an increase in its prevalence, smoking habit and underdiagnosis.

A Multidisciplinary Approach to Suicide Prevention in an Outpatient Setting

IntroductionThe incidence of suicide is much higher in people with mental health disorders, estimating that up to 9 out of 10 people who commit suicide suffer from at least one of them. For this reason, suicide is considered by many authors as the most serious complication of psychiatric disorders. The literature and the experience of clinicians support the potential usefulness of specific measures and programs aimed at its prevention.ObjectivesCongruently, throughout the last decade, consecutive strategic mental health plans in the Autonomous Community of Madrid, Spain, have included suicide prevention plans among their priorities, setting the objective of reducing suicidal behavior in the population of Madrid by implementing practical measures in the healthcare system.MethodsIn the presented work we aim to summarize the multidisciplinary therapeutic process in the context of this program and the results obtained during its years of experience.ResultsRetiro Community Mental Health Treatment Center launched a specific program in 2013 to meet these objectives. This initiative, that received the name PRISURE (Spanish acronym for Suicide Risk Prevention Program in Retiro), is an outpatient intervention program for immediate care, as the first appointment is scheduled within a week after referral. Intensive, comprehensive and multidisciplinary care is provided for patients with moderate to severe suicide risk.ConclusionsAll professional categories that work in the Community Mental Health Treatment Center actively participate. In parallel with clinical performance, these professionals also carry out coordination tasks with other entities that are dedicated to suicide prevention, as well as with patients’ and families’ associations.DisclosureNo significant relationships.