RESUMEN Fundamentos: La calidad en la humanización de la asistencia sanitaria implica el cuidado integral de los pacientes, considerando todas las facetas de la persona, incluida también su dimensión espiritual y religiosa. El objetivo de este estudio fue conocer la visión de los profesionales respecto al cuidado de esta dimensión en los pacientes atendidos en un hospital comarcal. Métodos: Se realizó un estudio descriptivo transversal, mediante una encuesta ad-hoc a profesionales sanitarios con 30 cuestiones (según escala de Likert, de 0=totalmente en desacuerdo a 4=totalmente de acuerdo), realizada en abril de 2017. El tamaño muestral necesario fue de 238. Se analizó con SPSS v19.0, se describieron la frecuencia absoluta y el porcentaje de acuerdos con cada cuestión, y se usó Chi-Cuadrado para valorar la asociación de las respuestas con el sexo y la categoría profesional, y ANOVA para la edad. Resultados: Se reclutaron 302 participantes. El 95,5% de mujeres destacó la importancia de crear un ambiente para que el paciente exprese su dimensión espiritual y/o religiosa, frente al 87,6% de hombres. A mayor edad, los profesionales diferenciaron mejor los conceptos de espiritualidad y religiosidad, y coincidieron en que ambas dimensiones afectaban al enfermo (diferencias entre 5-8 años de edad media). Los médicos estuvieron más de acuerdo con la importancia de la espiritualidad, seguidos de los enfermeros y los auxiliares, con diferencias significativas en 17 cuestiones. Conclusiones: Los profesionales reconocen la importancia de cuidar la dimensión espiritual y/o religiosa, con algunas diferencias entre categorías profesionales, sexo y edad. La formación en estos temas favorecería una atención más integral y de calidad en la asistencia.

ABSTRACT Background: To treat whole patient, spiritual and religious dimension included, allows improve the quality humanization healthcare. The aim of this study was to know the point of professional view regarding to assess this dimensions in patients attended in regional hospital. Methods: Cross-sectional descriptive study, through an ad-hoc survey with 30 issues (Likert 0: strongly disagree with 4: strongly agree), to health professionals, conducted in April 2017. Necessary sample size: 238. The SPSS (v19.0) statistical analysis was used. We calculated the absolute frequency and percentage of answers with each question and we used Chi-Square to assess the association of the answers with sex and professional category and ANOVA for age. Results: We recruited 302 participants. 95.5% of women stand out the importance of creating an environment to express their spiritual and/or religious dimension the patient, compared to 87.6% of men (p = 0.017). At an older age, professionals differentiated the concepts of spirituality and religiosity better and agreed that both dimensions affected the patient (differences between 5-8 years of average age). The doctors were more in agreement with the importance of spirituality, followed by nurses and less auxiliaries, with significant differences in 17 issues. Conclusions: The professionals recognized the importance of taking care of the spiritual and/or religious dimension, with some differences between professional categories, sex and age. Training in these subjects would favor a more comprehensive and quality assistance.

RESUMEN Fundamentos: La calidad en la humanización de la asistencia sanitaria implica el cuidado integral de los pacientes, considerando todas las facetas de la persona, incluida también su dimensión espiritual y religiosa. El objetivo de este estudio fue conocer la visión de los profesionales respecto al cuidado de esta dimensión en los pacientes atendidos en un hospital comarcal. Métodos: Se realizó un estudio descriptivo transversal, mediante una encuesta ad-hoc a profesionales sanitarios con 30 cuestiones (según escala de Likert, de 0=totalmente en desacuerdo a 4=totalmente de acuerdo), realizada en abril de 2017. El tamaño muestral necesario fue de 238. Se analizó con SPSS v19.0, se describieron la frecuencia absoluta y el porcentaje de acuerdos con cada cuestión, y se usó Chi-Cuadrado para valorar la asociación de las respuestas con el sexo y la categoría profesional, y ANOVA para la edad. Resultados: Se reclutaron 302 participantes. El 95,5% de mujeres destacó la importancia de crear un ambiente para que el paciente exprese su dimensión espiritual y/o religiosa, frente al 87,6% de hombres. A mayor edad, los profesionales diferenciaron mejor los conceptos de espiritualidad y religiosidad, y coincidieron en que ambas dimensiones afectaban al enfermo (diferencias entre 5-8 años de edad media). Los médicos estuvieron más de acuerdo con la importancia de la espiritualidad, seguidos de los enfermeros y los auxiliares, con diferencias significativas en 17 cuestiones. Conclusiones: Los profesionales reconocen la importancia de cuidar la dimensión espiritual y/o religiosa, con algunas diferencias entre categorías profesionales, sexo y edad. La formación en estos temas favorecería una atención más integral y de calidad en la asistencia.

ABSTRACT Background: To treat whole patient, spiritual and religious dimension included, allows improve the quality humanization healthcare. The aim of this study was to know the point of professional view regarding to assess this dimensions in patients attended in regional hospital. Methods: Cross-sectional descriptive study, through an ad-hoc survey with 30 issues (Likert 0: strongly disagree with 4: strongly agree), to health professionals, conducted in April 2017. Necessary sample size: 238. The SPSS (v19.0) statistical analysis was used. We calculated the absolute frequency and percentage of answers with each question and we used Chi-Square to assess the association of the answers with sex and professional category and ANOVA for age. Results: We recruited 302 participants. 95.5% of women stand out the importance of creating an environment to express their spiritual and/or religious dimension the patient, compared to 87.6% of men (p = 0.017). At an older age, professionals differentiated the concepts of spirituality and religiosity better and agreed that both dimensions affected the patient (differences between 5-8 years of average age). The doctors were more in agreement with the importance of spirituality, followed by nurses and less auxiliaries, with significant differences in 17 issues. Conclusions: The professionals recognized the importance of taking care of the spiritual and/or religious dimension, with some differences between professional categories, sex and age. Training in these subjects would favor a more comprehensive and quality assistance.

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Abstract The health and economic impact of allergic diseases are increasing rapidly, and changes in management strategies are required. Its influence reduces the capacity of work and school performance by at least a third. The ICPs of the airways (integrated care pathways for respiratory diseases) are structured multidisciplinary healthcare plans, promoting the recommendations of the guidelines in local protocols and their application to clinical practice. This document presents an executive summary for Argentina, Mexico, and Spain. Next-generation ARIA guidelines are being developed for the pharmacological treatment of allergic rhinitis (AR), using the GRADE-based guidelines for AR, tested with real-life evidence provided by mobile technology with visual analogue scales. It is concluded that in the AR treatment, H1-antihistamines are less effective than intranasal corticosteroids (INCS), in severe AR the INCS represent the first line of treatment, and intranasal combination INCS + anti-H1 is more effective than monotherapy. However, according to the MASK real-life observational study, patients have poor adherence to treatment and often self-medicate, according to their needs.

Abstract Although there are high quality clinical guidelines about allergic rhinitis, many patients receive deficient treatment, partly due to the high level of self-medication. MASK (Mobile Airways Sentinel Network) is an integral part of a project against chronic diseases which it is focused on active and healthy aging and is supported by the European Union. It forms the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma) in which, through a mobile app on a smart device, the purpose is to guide patients in the control of their multimorbidity, allergic rhinitis or conjunctivitis, or asthma. The "Allergy Diary" app by MACVIA-ARIA is free and it is available for Android and iOS; on it, patients indicate how unpleasant the symptoms are on a daily basis through five screens with an analogous visual scale; two more screens were recently added (sleep affectation). With the app, it is also possible to download the information of the “Allergy Diary” on the physician’s computer through a QR code at the moment of the medical consultation. In this article, we review the first year of experience in Spain, Mexico and Argentina, where the Spanish version is used.

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Abstract The vast majority of patients with allergic rhinitis (AR) do not receive the proper management which is recommended by the guidelines, but they frequently self-medicate. MASK (Mobile Airways Sentinel Network) is an integral part of a project that is supported by the European Union against chronic diseases and focused on active and healthy aging. MASK represents the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma), in which, by using a mobile application in a smart device, the objective is to guide the patient in the control of his/her multi-morbidity, AR and/or allergic conjunctivitis (AC) and/or asthma. The mobile app Allergy Diary by MACVIA-ARIA is free and it is available for both Android and iOS platforms. After it is downloaded to the patient’s cell phone, it first requests some information about the patient’s profile, allergic pathologies and medication; afterwards, through a visual analog scale, the patient is invited to determine the degree of affectation in the nose, eyes, and bronchi, and its influence on their productivity at work / school. After analyzing the data generated by filling the Allergy Diary, it became clear there is a new clinical entity: allergic rhinitis+ allergic conjunctivitis +asthma, with greater effect; in addition to a high level of self-medication: in general, the patient takes medication on days when symptoms are present. The app has already been deployed in 23 countries, including several Spanish-speaking countries.

Resumen Introducción: La infección respiratoria aguda baja (IRAB) es uno de los principales problemas de salud pública en menores de 5 años en países en desarrollo. El objetivo de este estudio fue describir la incidencia, mortalidad y factores pronósticos en pacientes menores de 5 años con diagnóstico de IRAB grave, en 2 hospitales de referencia de Popayán, Colombia. Materiales y métodos: Estudio de cohorte. Se incluyeron niños entre 2 meses y 5 años con diagnóstico de IRAB grave (neumonía adquirida en comunidad o bronquiolitis). Se recolectaron datos sociodemográficos, paraclínicos y de pronóstico. Los desenlaces de interés fueron la incidencia de muerte, de ingreso a uci y el tiempo de estancia hospitalaria. Se realizó análisis multivariante para evaluar el efecto de factores pronósticos. Resultados: Se incluyeron 121 casos. La incidencia de IRAB grave durante seis meses de seguimiento fue 4% ic95% (3,3-4,7). La mortalidad estimada durante el seguimiento fue 0,8% ic95% (0,1-4,4) -1 paciente-. El 33 % de los niños requirió ingreso a UCIP. La mediana de hospitalización global fue 5 días y de estancia en UCIP 4 días. El antecedente de nacimiento pretérmino se asoció de forma independiente con el ingreso a UCIP (or=5,1 ic95 % [1,3-20] p=0,019). Discusión: La incidencia de IRAB grave fue de 4%. La mortalidad asociada fue baja y el tiempo de estancia hospitalaria corto. Los factores relacionados a la presentación de IRAB son consistentes con los documentados en la literatura nacional e internacional; único factor pronóstico de importancia para ingreso a UCIP fue el nacimiento prematuro.

Abstract Introduction: Acute lower respiratory infection (ALRI: community acquired and/or bronchiolitis) is one of the main public health issues for children under five years of age. The main purpose of this research was to describe the epidemiological profile, associated factors, and prognosis of ALRI in two hospitals in Popayán, Colombia. Materials and Methods: This was a cohort study. We included children from 2 months to 5 years of age with diagnoses of severe ALRI. Socio-demographic profiles, clinical features, and prognostic factors were collected. The main outcomes under study were mortality, admission to ICU, and length of stay. Multivariable analyses were performed to establish the independent contributions of prognostic factors. Results: 121 patients were included. Incidence of ALRI was 4% ci95% [3,3-4,7] during 6 months of follow-up. Mortality during follow-up was 0,8% (ci95% 0,1-4,4) (one patient). Thirty three percent of children required admission to ICU. Median length of stay was 5 days and length of stay in ICU was 4 days. Preterm birth was independently associated with ICU admission (or=5,1 ci95% [1,3-20] p=0,019). Discussion: The incidence of severe ALRI was 4%. Mortality was low and length of stay was short. Factors related to the diagnosis of ALRI in this cohort are consistent with those reported in the national and international literature, and the only independent prognostic factor for admission to ICU was preterm birth.

Resumo Introdução: A infeção respiratória aguda baixa (IRAB) é um dos principais problemas de saúde pública em crianças menores de 5 anos em países em desenvolvimento. O objetivo deste estudo foi descrever a incidência, mortalidade e fatores prognósticos em pacientes menores de 5 anos com diagnóstico de IRAB grave em 2 hospitais de referência de Popayán, Colômbia. Materiais e métodos: Estudo de coorte. Incluíram-se crianças entre 2 meses e 5 anos com diagnóstico de IRAB grave (pneumonia adquirida em comunidade e/ou bronquite). Coletaram-se dados sociodemográficos, paraclínicos e de prognóstico. Os desenlaces de interesse foram a incidência de morte, de ingresso a uci e o tempo de estadia hospitalar. Se realizou uma análise multivariada para avaliar o efeito de fatores prognósticos. Resultados: Incluíram-se 121 casos. A incidência de IRAB grave durante seis meses de seguimento foi 4% ic95% [3,3-4,7]. A mortalidade estimada durante o seguimento foi 0,8% ic95% [0,1-4,4] (1 paciente). O 33% de crianças requereu ingresso a UCIP. A mediana de hospitalização global foi 5 dias e de estadia na UCIP 4 dias. O antecedente de nascimento pré-termo associou-se de forma independente com o ingresso à UCIP (or=5,1 ic95 % [1,3-20] p=0,019). Discussão: A incidência de IRAB grave foi de 4%. A mortalidade associada foi baixa e o tempo de estadia hospitalar curto. Os fatores relacionados à apresentação de IRAB são consistentes com os documentados na literatura nacional e internacional e o único fator prognóstico de importância para ingresso à UCIP foi a história de prematuridade.

RESUMEN Fundamentos: Los ingresos hospitalarios evitables por insuficiencia cardiaca (IC) son un problema para los sistemas de salud, consumen recursos, generan morbilidades adicionales y alta mortalidad. El objetivo del estudio fue conocer los factores de riesgo de las personas hospitalizadas por insuficiencia cardiaca. Métodos: Se constituyó un grupo con médicos de atención primaria y hospitalaria. Se realizaron auditorías de las historias clínicas de 110 pacientes de la población de la comarca del Aljarafe con mayores tasas de ingreso por insuficiencia cardiaca y estudio descriptivo y comparativo con T-Student y U-Mann Whitney para cuantitativas y λ2 y Fisher para cualitativas. Resultados: Los pacientes que ingresaron por IC tenían 78,1 años (SD: 9,56) de media; 73 (66,4%) fueron mujeres; un Índice Barthel de 45,0 de media; un 53,5% con grado III de la NYHA y 17 (15,5%) institucionalizados. El 70% presentaban 3-5 comorbilidades, hipertensión (87,3%), dislipemia (60,0%) diabetes (57,3%), enfermedad renal crónica (56,4%), anemia (53,2%) o fibrilación auricular (52,7%). Fallecieron al ingreso 23 (20,9%) pacientes. Conclusiones: Los ingresos se dieron en personas mayores con múltiples enfermedades (hipertensión, diabetes, EPOC, enfermedad renal) y escasa capacidad para actividades básicas de la vida diaria. El fallecimiento hospitalario se asoció a edad avanzada, ser mujer, menor uso de betabloqueantes y la no inclusión del paciente en el proceso asistencial.

ABSTRACT Background: The avoidable hospital admissions for heart failure are a problem for health systems worldwide, as they waste resources, generate additional morbidities and high mortality. The objective of this study was to determine the risk factors in patients hospitalized for heart failure to prevent further unplanned admissions. Methods: A group of medical from Hospital and Primary Care was established. We realized an audit of a sample of 110 patients from Aljarafe towns with highest hospital admissions for heart failure. The analysis used Student T test and Mann Whitney for quantitative variables; λ2 test and Fisher exact test for qualitative variables. Results: Patients admitted for HF had a mean age of 78.1 years (SD: 9.56); 73 (66.4%) were women; Barthel Index was 45.0 on average; 53.5% had NYHA class III and 17 (15.5%) were institutionalized, 70% had between 3 and 5 comorbidities, mainly hypertension (87.3%), dyslipidemia (60.0%), diabetes (57.3%), chronic kidney disease (56.4%), anemia (53.2% ) or atrial fibrillation (52.7%). During hospitalization, 23 patients (20.9%) died. They were mostly women, elderly, had a previous admission and without beta-blockers treatment. The admission in the last 12 months was associated with identification of the primary caregiver; ischemic HF; revascularization; inclusion in the COMPARTE Program; treatment change decompensation. Conclusions: The hospital admissions were more frequently an aging population with multiple diseases (hypertension, diabetes, COPD, renal disease) and low capacity for basic activities of daily life. The hospital mortality associated with elderly, women, less use of beta-blockers and the non-inclusion of the patient in the care process.

ABSTRACT Background: The avoidable hospital admissions for heart failure are a problem for health systems worldwide, as they waste resources, generate additional morbidities and high mortality. The objective of this study was to determine the risk factors in patients hospitalized for heart failure to prevent further unplanned admissions. Methods: A group of medical from Hospital and Primary Care was established. We realized an audit of a sample of 110 patients from Aljarafe towns with highest hospital admissions for heart failure. The analysis used Student T test and Mann Whitney for quantitative variables; λ2 test and Fisher exact test for qualitative variables. Results: Patients admitted for HF had a mean age of 78.1 years (SD: 9.56); 73 (66.4%) were women; Barthel Index was 45.0 on average; 53.5% had NYHA class III and 17 (15.5%) were institutionalized, 70% had between 3 and 5 comorbidities, mainly hypertension (87.3%), dyslipidemia (60.0%), diabetes (57.3%), chronic kidney disease (56.4%), anemia (53.2% ) or atrial fibrillation (52.7%). During hospitalization, 23 patients (20.9%) died. They were mostly women, elderly, had a previous admission and without beta-blockers treatment. The admission in the last 12 months was associated with identification of the primary caregiver; ischemic HF; revascularization; inclusion in the COMPARTE Program; treatment change decompensation. Conclusions: The hospital admissions were more frequently an aging population with multiple diseases (hypertension, diabetes, COPD, renal disease) and low capacity for basic activities of daily life. The hospital mortality associated with elderly, women, less use of beta-blockers and the non-inclusion of the patient in the care process.

RESUMEN Fundamentos: Los ingresos hospitalarios evitables por insuficiencia cardiaca (IC) son un problema para los sistemas de salud, consumen recursos, generan morbilidades adicionales y alta mortalidad. El objetivo del estudio fue conocer los factores de riesgo de las personas hospitalizadas por insuficiencia cardiaca. Métodos: Se constituyó un grupo con médicos de atención primaria y hospitalaria. Se realizaron auditorías de las historias clínicas de 110 pacientes de la población de la comarca del Aljarafe con mayores tasas de ingreso por insuficiencia cardiaca y estudio descriptivo y comparativo con T-Student y U-Mann Whitney para cuantitativas y λ2 y Fisher para cualitativas. Resultados: Los pacientes que ingresaron por IC tenían 78,1 años (SD: 9,56) de media; 73 (66,4%) fueron mujeres; un Índice Barthel de 45,0 de media; un 53,5% con grado III de la NYHA y 17 (15,5%) institucionalizados. El 70% presentaban 3-5 comorbilidades, hipertensión (87,3%), dislipemia (60,0%) diabetes (57,3%), enfermedad renal crónica (56,4%), anemia (53,2%) o fibrilación auricular (52,7%). Fallecieron al ingreso 23 (20,9%) pacientes. Conclusiones: Los ingresos se dieron en personas mayores con múltiples enfermedades (hipertensión, diabetes, EPOC, enfermedad renal) y escasa capacidad para actividades básicas de la vida diaria. El fallecimiento hospitalario se asoció a edad avanzada, ser mujer, menor uso de betabloqueantes y la no inclusión del paciente en el proceso asistencial.

Sexual dysfunction disorders are not infrequent in people with Terminal Chronic Renal Insufficiency undergoing dialysis. Our aim was to find out the sexual behaviour in haemodialysis patients in Melilla, and determine whether they suffered any sexual alteration or dysfunction. This is a transversal descriptive study carried out on a sample of 38 patients. The data were compiled on a questionnaire prepared for this purpose which was submitted to the opinion of experts and was tranlated into Arabic due to the language barrier. The results show that 57.89% are women and 42.10% are men. The average age is around 40 in men and 70 in women. Sex drive has fallen in 56.25% of the men and 31.8% of the women since they have been on haemodialysis. The reduction in libido affects women more than men. 75% of the men would be willing to treat the sexual dysfunction and 37.5% list the psychological factor as the cause.

Los trastornos de la disfunción sexual no son infrecuentes en las personas con Insuficiencia Renal Crónica Terminal en diálisis. Nuestro objetivo fue conocer el comportamiento sexual en los pacientes de Hemodiálisis en Melilla, y saber si padecen alguna alteración o disfunción sexual. Se trata de estudio descriptivo transversal en una muestra de 38 pacientes. Se recogen los datos en un cuestionario confeccionado para tal fin que se sometió a un juicio de expertos y se tradujo al árabe por la barrera idiomática. Los resultados muestran que el 57.89% son mujeres y el 42.10% varones. La edad media oscila entre los 40 en varones y los 70 años en mujeres. En el 56.25% de lo varones y el 31.8% de las mujeres han disminuido el deseo sexual desde que están en Hemodiálisis. La disminución de la libido afecta más a las mujeres que a los varones. Estarían dispuestos a tratar la disfunción sexual el 75% de los hombres y el 37.5% relacionan el factor psicológico como causante.

Introduction: Approximately 3% of malignant tumors originate in the oral cavity. The majority are squamous cell carcinomas, and a small percentage, malignant tumors of the salivary glands, lymphoreticular diseases, bone tumors, melanomas, sarcomas, malignant odontogenic tumors and metastases of tumors from other locations. The prognosis of these pathologies depends on the size, infiltration, and site of the lesion, the presence or absence of metastatic spread, and to a certain degree the differentiation of the tumor. The prognosis of an oral cancer remains generally negative, with 5-year survival figures below 50%, producing high rates of mortality and morbidity. Objectives: To evaluate the influence of different variables on survival in an oral cancer population. Patients and methods: Two-hundred and sixteen patients with oral squamous cell carcinoma were studied over a period of five years, evaluating 42 variables grouped into five data sections: personal, lesion, site, stage, and risk factors. Results and conclusions: Average survival was 2088 days, with a standard deviation of 98 days. The factors most associated with mortality were: location in the gingiva (p=0.0590), in the trigone (p=0.0104), size (T3-T4) (p=0.0004) and lymph node involvement (N2a-N2b) (p=0.0035). Tobacco and alcohol, nowadays considered to be highly significant in carcinogenesis, had no considerable influence on survival.

Introducción: aproximadamente un 3% de los tumores malignos se origina en la cavidad oral. La mayoría corresponden a carcinomas de células escamosas, y un pequeño porcentaje a tumores malignos de glándulas salivares, enfermedades linforeticulares, tumores óseos, melanomas, sarcomas, tumores malignos odontogénicos y metástasis de tumores de otras localizaciones. El pronóstico de estas patologías depende del tamaño, infiltración y localización de la lesión, presencia o ausencia de extensión metastática y en cierto grado de la diferenciación del tumor1. La patología neoplásica oral aún mantiene un pronóstico general negativo, con unas cifras globales de supervivencia a los 5 años menores del 50%, produciendo altas tasa de mortalidad y morbilidad2,3. Objetivo: evaluar la carga de distintas variables sobre el tiempo de supervivencia en una población con cáncer oral. Pacientes y metodo: sobre 216 paciente realizamos un estudio de casos de cáncer de oral de células escamosas a 5 años, evaluando 42 variables, agrupadas en cinco apartados: datos personales, de la lesión, localización, estadiaje y factores de riesgo. Resultados y conclusiones: el tiempo medio de supervivencia fue 2088 días, con un error estándar de 98 días. Los factores asociados a mayor mortalidad fueron: localización en la encía (p= 0.0590), en trígono (p= 0.0104), el tamaño (T3-T4) (p= 0.0004) y afectación ganglionar (N2a-N2b) (p= 0.0035). El tabaco y el alcohol, considerados hoy de gran importancia en la génesis del cáncer, no influyeron considerablemente en el tiempo de supervivencia.