Autonomous Region Of Madrid Research Articles

Estrategia de implantación y evaluación de una unidad funcional de gestión de riesgos sanitarios en un área de atención primaria

ObjectiveTo describe the setting up of a clinical risk management unit (CRMU) within primary care management, as well as the aims of the project, its implementation phases and the assessment of the results after one year of experience. MethodsA safety plan was prepared, based on the European Excellence Model (EFQM), to establish a strategic working framework. The plan included 38 proposed actions, associated with criteria elements and 26 indicators to evaluate the selected criteria. ResultsA total of 82% of the anticipated actions were implemented in 2007, which included, actions related to teaching and training (15 activities with 237 trainees), spreading of information associated with patient safety, incident analysis (14) and the introduction of specific safe practices (12). Four of those were considered as “generalisable” safe practices and were spread to the rest of the CRMUs in the Autonomous Region of Madrid. The CRMUs have introduced and monitored three processes related to patient safety, participated in a formal programme on the polymedicated elderly, with good results in cover and quality of the indicators. A primary care team (PCT) from the area took part in the first study carried out in Spain on adverse effects in primary care (APEAS Study). ConclusionsThe CRMU can give impetus to strategic lines of safety. The preparation of a strategy defining specific aims has helped in the introduction of patient safety activities and along with the proposed indicators enables the impact of the intervention to be assessed.

Validación de la Escala de Independencia Funcional

Objective To assess the psychometric quality of an instrument designed to measure functional independence (Functional Independence Scale [FIS]) in several activities of daily living domains and to be applied by trained non-health-related interviewers. The study was carried out in the autonomous region of Madrid in community-dwelling elders. Methods We performed a cross-sectional validation study. In addition to the FIS, Pfeiffer's questionnaire, the Depression Subscale of the Hospital Anxiety and Depression Scale, the Comorbidity Index, the Barthel Index, and EQ-5D were used. These measures were cross-sectionally applied to community-dwelling elders ( n=500) and outpatients in a general hospital ( n=100) aged ⩾65 years. The following FIS psychometric attributes were analyzed: acceptability, scaling assumptions, internal consistency, construct validity, and precision. Results A fully computable FIS total score was obtained in 94.3% of the subjects. A ceiling effect (60.65%), but no floor effect (0.22%) was evident in the community-dwelling elders. No floor or ceiling effects were detected in the hospital sample. Scaling assumptions and internal consistency were satisfactory (item-total correlations: 0.57–0.91; Cronbach's alpha: 0.94). Factor analysis identified three factors that explained 74.3% of the variance. Indexes of convergent, internal, and known-groups validity were satisfactory. The scale's precision, determined by the standard error of measurement (2.49; 95%CI=4.88), was also satisfactory. Conclusion The FIS is an easy-to-use instrument with appropriate metric attributes. This scale can be usefully applied in broad samples of non-institutionalized elders by non-health related personnel.

Uso de sujeciones físicas en una población anciana ingresada en residencias públicas

To determine the prevalence of the use of physical restraints in public nursing homes through the Residents' Functional Classification Information System in order to assess the introduction of a protocol designed to reduce and rationalize the use of these devices. Twenty-five public nursing homes in the autonomous region of Madrid were included in this study. The following data on the use of physical restraints were analysed: frequency of use (daily or less than daily), type of device, level of functional dependence for activities of daily living, and severity of cognitive impairment. A total of 5346 residents were included. The prevalence of the use of restraints was 8.4%. When the use of bedrails was added, this percentage rose to 20.8%. Bedrails accounted for 63.4% of all restraints used, trunk restraints for 17.7%, limb restraints for 3%, and chairs preventing voluntary rising for 15.9%. A single device was used in 62.6%. Of the restraints, 71.4% were used daily and 28.6% were used temporarily. The results of this study represent an approximation to the current use of physical restraints in nursing homes. The prevalence found was similar to, or less than, that observed in previous studies. The most commonly used form of restraint was bedrails. The use of these devices is probably excessive, affecting even residents without cognitive impairment or physical dependence. To reduce the use of restraints and guarantee optimal care when their application is indicated, the Regional Social Welfare Service systematically applies a protocol for the prevention and use of physical restraints.

El futuro del profesional de la información en la Comunidad de Madrid: propuesta de la <i>Plataforma para el colegio de archiveros, bibliotecarios y documentalistas</i>

Since March 2007, a group of information professionals from the autonomous region of Madrid has been working voluntarily and independently on the creation of a professional college for archivists, librarians and information scientists. However, it is necessary to present a bill at the region’s Parliament to be finally approved into law. This action developed as a reaction against the lack of an official organism to regularise this profession. The professional college will be in charge of representing and defending the profession and maintaining the relations with central and regional governments, the private sector, other professional colleges and universities.

Insomnio y calidad del sueño en médicos de atención primaria: una perspectiva de género

To assess insomnia and sleep quality in primary care physicians from a gender perspective.A representative sample of 240 physicians was drawn from 70 medical centers from the Madrid Autonomous region. The participation rate was 71.6%. The questionnaire included sociodemographic data, insomnia symptomatology using DSM-IV criteria and the Pittsburgh Sleep Quality Index (PSQI).18.8% of the total sample met DSM-IV criteria for insomnia diagnosis, with higher frequency among women (23%) compared to men (9.6%). The same pattern appeared for early morning awakening and daytime impairment. Results of logistic regression analyses showed that, after controlling for sociodemographic variables, this relationship between gender and insomnia remained significant. Furthermore, the results indicate that women scored significantly higher than men on global sleep quality and on its components. A PSQI global score = or > 5 is an optimal cut-off score for distinguishing good sleepers from subjects with clinical sleep problems. Following this criteria, 35.4% of physicians had sleep problems, with a significant higher prevalence among women (40% vs. 25.3%).The data indicates that the prevalence of sleep disturbances is high among primary care physicians, especially among women.

Incidence trends in pertussis in the Autonomous Region of Madrid, Spain: 1982-2005

The objective of this study was to describe the incidence (1982-2005) and epidemiologic characteristics of pertussis cases (1998-2005) in the Autonomous Region of Madrid using data drawn from the epidemiologic surveillance network and computerised hospital discharge data. In the 1990s, the trend in the pertussis incidence in the Autonomous Region of Madrid was clearly falling. The typical seasonal pattern of pertussis remained. A peak in incidence were observed in 2000, and another peak, 2.5 times higher, in 2003. They affected all age groups, but children under one year of age were the most frequent cases, followed by the five to nine year-olds. The greatest increase was seen in the age groups from 10 to 14 and from five to nine. Since 2002, the proportion of cases diagnosed serologically has increased. The incidence of hospital discharges among small children exceeded that of reported cases. More than half of the cases with known vaccination status had received at least three doses of vaccine. The upward trend observed since 2002 could be due to improved case detection, availability of serologic techniques, and a rise in the susceptible population aged five to 14 years. The fact that epidemic peaks continue to occur and that there is a seasonality to the disease seems to indicate that despite the vaccination programme the circulation of the bacteria has not been interrupted. The introduction of the acellular vaccine in 2000 does not appear to have played a significant role in the increase in disease incidence.

Varicella and Herpes Zoster in Madrid, based on the Sentinel General Practitioner Network: 1997–2004

BackgroundVaricella (chickenpox) is the primary disease caused by varicella-zoster virus. It is extremely contagious and is frequent in children. Indeed, in the absence of vaccination, a high proportion of the population is liable to contract it. Herpes zoster -more frequent among adults- is caused by reactivation of the latent virus. The objective of this study is to describe the status of and time trend for varicella and herpes zoster in the Madrid Autonomous Region prior to the introduction of the vaccine to the general population.MethodsData source: individualised varicella and herpes zoster case records kept by the Madrid Autonomous Region Sentinel General Practitioner Network for the period 1997–2004. Cumulative incidences, crude and standardised incidence rates, and age-specific rates of varicella and herpes zoster were calculated for each year. Kendall's Tau-b correlation coefficient was calculated to evaluate whether incidence displayed a time trend. Spectral density in the time series of weekly incidences was estimated using a periodogram.ResultsStandardised annual varicella incidence rates ranged from 742.5 (95% CI: 687.2 – 797.7) to 1239.6 (95% CI: 1164.5 – 1313.4) cases per 100 000 person-years. Most cases affected children, though complications were more frequent in adults. Varicella incidence displayed an annual periodicity but no trend over time. Most herpes zoster cases occurred at advanced ages, with incidence registering a rising annual trend but no seasonality factor.ConclusionIn the absence of vaccination, no significant changes in varicella incidence were in evidence recent years, though these were observed in the incidence of herpes zoster. Sentinel general practitioner networks are a valid instrument for surveillance of diseases such as varicella. Further varicella vaccination-coverage and vaccine-efficacy studies are called for.

Innovación y eficacia en atención a la diversidad en educación secundaria obligatoria

La atención a la diversidad es una de las medidas educativas diseñadas para mejorar la eficacia y la equidad del sistema educativo. Este artículo se centra en el análisis de las medidas desarrolladas en Educación Secundaria Obligatoria en la Comunidad de Madrid y presenta los resultados de las entrevistas realizadas a 14 centros identificados y seleccionados por sus proyectos de carácter innovador con el objetivo de conocer el escenario y elaborar pautas de acción y mejora dirigidas a los centros de similares características y contextos. El análisis pone en evidencia la necesidad de formar equipos docentes cohesionados e implicados que afronten de manera positiva la problemática específica de su centro, que discutan y consensuen los programas o las formas de intervención más adecuadas en función de las necesidades de los estudiantes; apoyados por el claustro, el equipo directivo y administrativo del centro y por la Administración de la que dependen, ya que en sus manos está en definitiva el que se disponga o no de las dotaciones requeridas. De las experiencias llevadas a cabo, despunta también la eficacia de intervenciones altamente estructuradas y con objetivos claros y operativos que permitan experimentar éxito a corto plazo y auto-control de los avances, así como de programas de atención individualizada adaptados a cada contexto o situación.

Ingresos hospitalarios atribuibles a rotavirus en niños de la Comunidad de Madrid, período 1999-2000

To assess rotavirus infection requiring hospitalization in children aged < or = 5 years between 1999 and 2000 in the Autonomous Region of Madrid (Spain).A retrospective study was conducted, based on the hospital data surveillance system (Conjunto Mínimo Básico de Datos [CMBD]) and on the Spanish national microbiological information system (Sistema de Información Microbiológica [SIM]). CMBD data for all hospital admissions in children aged < or = 5 years with a first-listed diagnosis of intestinal infectious disease (ICD-9-CM codes: 001-009) or non-infective gastroenteritis (ICD-9-CM code: 558) and the reports to the SIM of the major pathogen groups responsible for acute gastroenteritis were analyzed.The annual incidence of hospitalizations for acute gastroenteritis was 69 cases per 10,000 children aged < or = 5 years. Fourteen percent of the 32,541 infections produced by pathogens responsible for acute gastroenteritis reported to the SIM were rotavirus. The estimated annual incidence of hospitalizations due to rotavirus infections was 12 cases per 10,000 children aged (3/4) 5 years. The mean length of stay was 4.0 days, the annual mean number of days of hospitalization was 1,382 days, and the annual cost was 565,907 J. During the rotavirus epidemic months (December and January), the percentage of excess hospitalizations was 67 %.Rotavirus causes a significant proportion of hospital admissions due to acute gastroenteritis in children aged < or = 5 years in the Autonomous Region of Madrid.

Sound exposure during daily activities

Throughout the day people carry out different activities in different places, and are therefore exposed to a wide range of sound environments. Sound exposure does not occur uniquely in the work situation, but is also caused by non-occupational activities, such as leisure, transportation, shopping, etc. This work shows the results of a study of the sound exposure experienced by a group of 32 people during one week in the Madrid Autonomous Region in Spain. The main aim of the study is to determine the average sound exposure perceived by an inhabitant of the Madrid region; to this end the sample was designed to comprise a cross-section of the population. An analysis was made of the activities that most affect sound exposure, and of the contribution of these activities to the total sound exposure. The results obtained show that in all population groups, sound exposure is greatest on weekends. Leisure activities contribute most to the total sound received, and young adults are subjected to the highest levels of sound exposure. The results obtained in this work may be useful for local authorities in planning environmental strategies.

CanalEduca, a comprehensive educational project on the environment by Canal de Isabel II

Canal de Isabel II, with over a decade of experience in the development of educational campaigns directed at schoolchildren in the first and second cycle of obligatory education (6 to 16 year-olds) in the Autonomous Region of Madrid, has developed and implemented, for the first time, an ambitious and comprehensive educational programme centred on environmental awareness in its broadest sense, making use of all the educational tools developed by new technologies and educational sciences, without any limit of age or boundaries. CanalEduca was established on this basis.

Outbreak of rubella in the Madrid region, Spain, 2005

There was an unexpected increase in the number of confirmed rubella cases notified in the autonomous region of Madrid during the first weeks of 2005.

Is there a change in cytomegalovirus seroepidemiology in Spain?

The aim of this paper is to compare the seroprevalence of cytomegalovirus (CMV) in women in the Autonomous Region of Madrid (ARM) obtained in two different years (1993 and 1999), according to age and seroprevalence of a virus transmitted by the faecal-oral route (hepatitis A virus, HAV) and another virus of respiratory transmission (varicella zoster virus, VZV). A total of 1813 serum samples were studied, taken from females aged 2-40 in two different serosurveys which were representative of the general population in the ARM. Of these, 933 were taken in 1993, and 880 in 1999. In each survey the samples were distributed over six groups, according to age group (2-5, 6-10, 11-15, 16-20, 21-30 and 31-40 years). CMV- and VZV-specific IgG was tested by indirect ELISA (Dade-Behring, Germany); and HAV-IgG by ImX (Abbott, USA) in the 1993 samples, or by Vidas (BioMérieux, France) in the case of those taken in 1999. A significant age-related rise in CMV seroprevalence was observed in both serosurveys. The seroprevalence obtained was lower in all age groups in 1999 than in 1993. The differences were statistically significant in two age groups: 6-10 years old (43.7 vs. 56.7%) and 31-40 years old (79.1 vs. 90.3%). In the younger age groups concurrent seroprevalence of CMV and VZV was significant lower in 1999. In older age groups a significant decrease in concurrent seroprevalence of both CMV and HAV was also seen. Agreement between serological results for CMV-HAV, CMV-VZV and HAV-VVZ during the two time periods and in every age group was poor or fair (kappa index < or = 0.2 or between 0.21 and 0.4) in all age groups. To conclude, a change in CMV epidemiology seems to be taking place in Madrid. The increase in the proportion of CMV seronegative women of childbearing age may have some impact on the incidence of congenital diseases related to vertical transmission of CMV. Apparently, such a change, among children, could be related to a lower close contact transmission rate (as in VZV), and among adults to improvements in standards of public health (as in HAV). However, due to the poor or fair agreement between serological results for CMV-HAV, CMV-VZV and HAV-VVZ, other independent factors may affect the fall in CMV seroprevalence.

Estudio epidemiológico y clínico de los pacientes diagnosticados de tuberculosis en el área noroeste de Madrid

Estimate the incidence and the epidemiological and clinical characteristics of patients diagnosed with tuberculosis in a county hospital located in the north western area of the Autonomous Region of Madrid, to determine if there has been an increase due to immigration.Tuberculosis cases from January, 1996 to June, 2001 were analysed, researched through the Microbiology and Pathologic Anatomy Laboratory, fetching information such as demographics, clinical studies and disease diagnostics from the different medical histories.A total of 66 tuberculosis cases were registered, ten of them among immigrants, with an incidence of 13/100,000 inhabitants in 1996, decreasing to a 7/100,000 incidence in 2000. The age average is 34 with double the incidence in males (31/100,000) than females (17/100,000). The main risk factor is alcoholism with 11 cases (16.7%). The most commonly used diagnostic tests were the thorax radiography (61/66, 92%) with 57 (93.4%) positive identifications, culture of esputo (47/66, 71%) with 32 (68%) positive ids, and the Mantoux test (28, 42%) with 20 (71.4%) positive ids. The location of the illness is mainly pleuro-pulmonar in 50 cases (75%). There were almost no atypical mycobacterium found (5 cases). Overall, response to treatment with 3 drugs (isoniacide, rifampicine, piracinamide) was good in 88% of patients, with the average treatment lasting 6.8 months (ED: 2.8).The incidence of tuberculosis in the north western area of Autonomous Community of Madrid is below that of the rest of our Community. It dipped in 1997 and has been stable around 9/100,000 inhabitants until 2000, even with the effect of immigration.

Relationship between atmospheric pressure and mortality in the Madrid Autonomous Region: a time-series study.

This study set out to determine the possible influence of variations in atmospheric pressure on mortality in the Madrid Autonomous Region (MAR), taking into account the possible confounding effect of other atmospheric variables. The study was based on daily mortality data from the MAR Revenue and Excise Authority, meteorological data from Getafe Observatory and air pollution data from the Madrid Municipal Automatic Air Pollution Monitoring Grid. A time-series analysis was performed, using Box-Jenkins modelling and controlling for the respective confounding variables. Furthermore, the different variables studied (pressure, temperature, pollutants, etc.) were used to produce a multivariate model of the different causes of mortality. A significant association was found between anticyclonic trend and mortality with circulatory causes in the medium-long term and anticyclonic trend and mortality with respiratory causes in the long term.

La europa del conocimiento en la EducaciÓn Secundaria Obligatoria

In the first place, this paper analyses the educational proposals the E.U.. considers the Member States ought to implement in order to cope with the economic and social challenges of the global information society. In the second place, the results of a questionnaire carried out by a number of Compulsory Secondary Education pupils from the Autonomous Region of Madrid helped us to determine their level of knowledge, attitudes and stereotypes about the construction of Europe. Our aim was to check whether the educational system really prepares them to be active citizens participating in the Europe of knowledge.

A Methodology for Environmental Planning in Protected Natural Areas

The primary objective of planning in protected natural areas should be the conservation of their inherent natural values. With this idea in mind, a proposal of an objective method for the environmental planning of a protected natural area is presented. The method used was principal components analysis, a multivariate analysis technique that integrates the natural value and the state of conservation (the degree of alteration due to human activity) of the main characteristics of the environment. The method is applied to the specific case of a protected natural area in the Comunidad de Madrid (Madrid Autonomous Region), Spain.

El consumo de información en la industria farmaceútica. I. Resultados del análisis de la demanda del CINDOC.

This article sets forth the main results of part of the research work performed by the author on companies in the pharmaceutical industry located in the Madrid Autonomous Region. The purpose of the study was to find out the consumption of information on the part of the pharmaceutical companies in the Region which are regular clients of the Scientific Information and Documentation Centre (CINDOC, which reports to the Spanish Research Council-CSIC) through the data included in its administrative archive, relating to information requests made by these companies in the period 1994-95. By means of bibliometric indicators, a detailed analysis has been made of the types and subjects of the most requested documents, their present importance, the language and country of publication, the topographic location and the supply thereof.

Seroepidemiological Study of Herpes Simplex Virus in the Female Population in the Autonomous Region of Madrid, Spain

Seroepidemiological Study of Herpes Simplex Virus in the Female Population in the Autonomous Region of Madrid, Spain

Daily mortality in Madrid community 1986-1992: relationship with meteorological variables.

Daily mortality displays a seasonal pattern linked to weather, air pollution, photoperiod length, influenza incidence and diet, among which temperature ranks as a leading cause. This study thus sought to assess the relationship between temperature, relative humidity, wind speed and mortality in the Madrid Autonomous Region (Spain) for the period January 1986-December 1992, controlling for the effects of air pollution and influenza incidence. Daily data on maximum, minimum and 24-hour mean temperature, relative humidity and wind speed were matched against daily mortality. Transfer function was identified using the Box-Jenkins pre-whitening method. Multivariate time series regression models were used to control for the confounding effects of air pollution and influenza incidence. Separate seasonal analyses were carried out for winter and summer periods. A J-shaped relationship between outdoor temperature, relative humidity and daily mortality was found. Mortality proved to be inversely related to cold temperature (4- to 11-day lag) and directly related to warm temperature (1-day lag). High relative humidity during summer periods was negatively related to mortality. Thermal variation ascribable to Madrid's mesothermal Mediterranean climate was strongly related to daily mortality, even where air pollution and influenza incidence were controlled for.