Introducción: El envejecimiento se acompaña de factores de riesgo cuya reducción mejora la supervivencia. La actividad física incide sobre ellos, lo que realza su papel preventivo y su valor como tratamiento no-farmacológico. Dada la escasez de programas de entrenamiento específicos para ancianos pluripatológicos, sobre todo durante el periodo de inicio de resolución de la actividad clínica de una enfermedad aguda, o de la exacerbación de una o varias de las enfermedades crónicas, el presente estudio piloto analiza la viabilidad y efectos de un programa corto de entrenamiento neuromotor en estos pacientes ingresados en UHD (Unidad de Hospitalización Domiciliaria). Método: 11 ancianos pluripatológicos (82,2±6,9 años, 8 hombres) completaron 4 semanas de entrenamiento funcional con orientación neuromuscular y cognitiva, con evaluación pre-post sobre capacidad funcional (equilibrio, marcha, fuerza de tren inferior y agilidad), composición corporal y calidad de vida -6 semanas, incluida la evaluación-. Se realizaron dos sesiones domiciliarias supervisadas y una tercera autónoma semanalmente. Resultados: Los ancianos mejoraron en equilibrio y marcha (Tinetti-total: 14,0±9,0 vs 17,9±7,3 puntos; p =0,007), fuerza (test sentarse y levantarse 30-s: 3,0±3,7 vs 4,1±4,1 reps.; p =0,034), agilidad (TUG-test categorizado; p =0,001) y peso (82,2±14,0 vs 79,2±13,9 kg; p =0,036), aunque no en calidad de vida relacionada con la salud (SF-36-v2: 32,9±7,8 vs 31,2±7,7 puntos; p =0,722). La presencia del técnico aumentó el cumplimiento un 20%. Conclusiones: El dinamismo de UHD es idóneo para implantar programas de actividad física especializada que frenen los efectos devastadores del binomio envejecimiento-inactividad. Una corta duración no les resta eficacia.   Introduction: Aging is linked to a various risk factors whose reduction improves survival. Physical activity affects many of them, what enhances its preventive role and its value as a non-pharmacological treatment. Given the scarcity of specific training programs for elderly people with multiple pathologies, especially during the start period of resolution of the clinical activity of an acute disease, or the exacerbation of one or several of the chronic diseases, the present pilot study aims to analyze the feasibility and effects of a short neuromotor training program in these patients admitted to UHD (Home Hospitalization Unit). Methods: 11 elderly patients (82.2±6.9 years, 8 men; acute phase of disease) completed 4 weeks of a neuromuscular and cognitive orientated functional training program, with pre-post assessment of functional capacity (i.e. balance, gait speed, lower limb strength and agility), body composition and quality of life -6 weeks, including the evaluation-. There were 2 supervised sessions and a third autonomous session every week. Results: Significant improvements were found in balance and gait (Tinetti-total: 14.0±9.0 vs 17.9±7.3 points; p =0.007), strength (30-seconds Chair Stand Test: 3.0±3; p =0.001), agility (TUG-test categorized; p =0.001) and weight (82.2±14.0 vs. 79.2±13.9 kg; p =0.036), but not in health-related quality of life (SF-36-v2: 32.9±7.8 vs 31.2±7.7 points; p =0.722). The technician’s presence increased adherence to the program by 20%. Conclusions: The dynamism of UHD is ideal for implementing specialized physical activity programs that counteract the devastating effects of the binomial aging-inactivity. A short duration does not reduce effectiveness.

Objetivo. Conocer la relación entre el nivel de independencia de un grupo de ancianos crónicos-pluripatológicos y paliativos (ACP-P) y la sobrecarga de sus cuidadores, tras un programa de entrenamiento multicomponente adaptado al ámbito domiciliario. Diseño mixto, cuantitativo y cuasiexperimental, con medidas repetidas en el factor Entrenamiento, y dos factores de agrupación: edad (70-79 y ≥80 años) y nivel de deambulación del ACP-P (anda/no anda). Emplazamiento. Intervención realizada en la Unidad de Hospitalización a Domicilio (UHD) del Hospital General de Alicante, durante 2014-2016. Participantes. 17 pacientes ACP-P, edad media 81,6 años (DE 5,6). Intervención. 3 sesiones semanales durante 26 semanas del programa de entrenamiento funcional-cognitivo EFAM-UVH©; 3 fases, reduciendo progresivamente la presencia del entrenador para fomentar la autonomía (28 sesiones supervisadas y 20 autónomas en total). Mediciones principales. Evaluación de Sobrecarga del cuidador (Zarit) y Nivel de independencia (Índice de Barthel “IB”), apoyados por indicadores fisiológicos y funcionales. Resultados. IB mejoró con el entrenamiento supervisado (p<0,05), y se mantuvo o descendió leve, aunque no significativamente, al aumentar la autonomía. Estas mejoras se acompañaron de una reducción en la sobrecarga del cuidador, con una dinámica similar, fundamentalmente en cuidadores del grupo <79 años y de los que no andan. No se encontró relación entre IB y Zarit, pero los deltas de ambas variables se asociaron en las fases supervisadas (r=-0,596, p= 0,015), reflejando el impacto del ejercicio. Conclusiones. El entrenamiento multicomponente ayuda a contener la sobrecarga del cuidador, reducida de forma concomitante al aumento de independencia del ACP-P entrenado. Este beneficio indirecto potencia la necesidad de equipos multidisciplinares y programas de ejercicio temprano y supervisado. Objective. To know the relationship between the level of independence of a group of chronic-pluripatological and palliative elders (ACP-P) and the overload of their caregivers, after a multicomponent training program adapted to the home environment. Design. Mixed, quantitative and quasi-experimental design, with repeated measures in the training factor, and two grouping factors: age (70-79 and ≥80 years) and the ambulation level of the ACP-P (walk / don't walk). Location. Intervention carried out in the Home Hospitalization Unit (HHU) of the General Hospital of Alicante, during 2014-2016. Participants. 17 ACP-P patients [81.6 years (SD5.6)]. Intervention. 3 weekly sessions for 26 weeks of the EFAM-UVH© multicomponent training program (functional + cognitive); 3 phases, progressively reducing the presence of the coach to promote autonomy (28 supervised and 20 autonomous sessions in total). Main measurements. Evaluation of caregiver overload (Zarit) and level of independence (Barthel Index “BI”) of the ACP-P, supported by physiological and functional indicators. Results. BI improved with supervised training (p <0.05), and remained or fell slightly, although not significantly, when increasing the autonomy. These improvements were accompanied by a reduction in the overload of the caregiver, with a similar dynamic, mainly in the caregivers of the group <79 years and those who do not walk. No relationship was found between IB and Zarit, but the deltas of both variables were associated in the supervised phases (r = -0.596, p = 0.015), reflecting the impact of physical exercise. Conclusions. Multicomponent exercise training at the HHU helps to contain the caregiver's overload, reduced concomitantly to the increased of independence of the trained ACP-P. This indirect benefit maximizes the need of multidisciplinary teams, and early and supervised physical exercise training programs. Objetivo. Conhecer a relação entre o nível de independência de um grupo de idosos pluripatológicos e paliativos crônicos (ACP-P) e a sobrecarga de seus cuidadores, após um programa de treinamento multicomponente adaptado ao ambiente doméstico. Desenho misto, quantitativo e quase experimental, com medidas repetidas no fator Treinamento e dois fatores de agrupamento: idade (70-79 e ≥80 anos) e nível de deambulação do ACP-P (caminhada / partida). Localização. Intervenção realizada na Unidade de Hospitalização Doméstica (UHD) do Hospital Geral de Alicante, durante o período 2014-2016. Participantes. 17 pacientes com ACP-P, com idade média de 81,6 anos (DP 5,6). Intervenção. 3 sessões semanais por 26 semanas do programa de treinamento cognitivo-funcional EFAM-UVH ©; 3 fases, reduzindo progressivamente a presença do treinador para promover a autonomia (28 sessões supervisionadas e 20 autônomas no total). Principais medidas. Avaliação da sobrecarga do cuidador (Zarit) e nível de independência (Índice de Barthel "IB"), apoiados por indicadores fisiológicos e funcionais. Resultados. O IB melhorou com o treinamento supervisionado (p <0,05) e permaneceu ou caiu ligeiramente, embora não significativamente, aumentando a autonomia. Essas melhorias foram acompanhadas por uma redução na sobrecarga do cuidador, com dinâmica semelhante, principalmente nos cuidadores do grupo <79 anos e naqueles que não andam. Não foi encontrada relação entre IB e Zarit, mas os deltas de ambas as variáveis ​​foram associados nas fases supervisionadas (r = -0,596, p = 0,015), refletindo o impacto do exercício. Conclusões. O treinamento multicomponente ajuda a conter a sobrecarga do cuidador, reduzida concomitantemente à crescente independência do ACP-P treinado. Esse benefício indireto aumenta a necessidade de equipes multidisciplinares e programas de exercícios precoces e supervisionados.

Introduction This study examines the frequency, associated factors, and characteristics of healthcare personnel coronavirus disease 2019 (COVID-19) cases in a healthcare department that comprises a tertiary hospital and its associated 12 primary healthcare centers. Methods This study included healthcare personnel that showed symptoms or were in contact with a COVID-19 case patient from March 2 to April 19, 2020. Their evolution and characteristics (age, sex, professional category, type of contact) were recorded. Correlations between the different characteristics and risk of developing COVID-19 and severe COVID-19 were analyzed using chi-square tests. Their magnitudes were quantified with ORs, AORs, and their 95% CIs using a logistic regression model. Results Of the 3,900 healthcare professionals in the department, 1,791 (45.9%) showed symptoms or were part of a contact tracing study. The prevalence of those with symptoms was 20.1% (784/3,900; 95% CI=18.8%, 21.4%), with COVID-19 was 4.0% (156/3,900; 95% CI=3.4%, 4.6%), and with severe COVID-19 was 0.5% (18/3,900; 95% CI=0.2%, 0.7%). The frequency of COVID-19 in symptomatic healthcare personnel with a non-protected exposure was 22.8% (112/491) and 13.7% (40/293) in those with a protected exposure (AOR=2.2, 95% CI=1.2, 3.9). The service in which the healthcare personnel performed their activity was not significantly associated with being diagnosed with COVID-19. A total of 26.3% (10/38) of male healthcare personnel with COVID-19 required hospitalization, compared with 6.8% (8/118) among female healthcare personnel (OR=4.9, 95% CI=1.8, 13.6). Conclusions A surveillance and monitoring program centered around healthcare personnel enables an understanding of the risk factors that lead to COVID-19 among this population. This knowledge allows the refinement of the strategies for disease control and prevention in healthcare personnel during the COVID-19 pandemic.

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