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Introduction To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age.Methods Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015–2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015–2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models.Results Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively.Conclusion This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.

Abstract Since its initial launching, ChatGPT has gained significant attention from the media, with many claiming that ChatGPT’s arrival is a transformative milestone in the advancement of the AI revolution. Our aim was to assess the performance of ChatGPT before and after teaching the triage of mass casualty incidents by utilizing a validated questionnaire specifically designed for such scenarios. In addition, we compared the triage performance between ChatGPT and medical students. Our cross-sectional study employed a mixed-methods analysis to assess the performance of ChatGPT in mass casualty incident triage, pre- and post-teaching of Simple Triage And Rapid Treatment (START) triage. After teaching the START triage algorithm, ChatGPT scored an overall triage accuracy of 80%, with only 20% of cases being over-triaged. The mean accuracy of medical students on the same questionnaire yielded 64.3%. Qualitative analysis on pre-determined themes on ‘walking-wounded’, ‘respiration’, ‘perfusion’, and ‘mental status’ on ChatGPT showed similar performance in pre- and post-teaching of START triage. Additional themes on ‘disclaimer’, ‘prediction’, ‘management plan’, and ‘assumption’ were identified during the thematic analysis. ChatGPT exhibited promising results in effectively responding to mass casualty incident questionnaires. Nevertheless, additional research is necessary to ensure its safety and efficacy before clinical implementation.

Abstract The war in Ukraine has led to complex emergencies, humanitarian crises, and other severe consequences, such as chemical industry disasters. The chemical industry is one of the principal sectors of Ukraine’s economy. In 2019, Ukraine had a total volume of hazardous chemical accumulation of more than a 5.1billion tons. Therefore, an attack on chemical industrial facilities will lead to catastrophic consequences such as chemical disasters. This paper aims to study the disaster risk of chemical industrial facilities and its effects on public health and the environment during complex emergencies in Eastern Ukraine. Observational cross-sectional risk assessment method was utilized to assess hazard, vulnerability, and exposure of the chemical industry in Eastern Ukraine in Donetsk Oblast and Luhansk Oblast. Data on chemical factories in Eastern Ukraine was collected on Google Maps and Google Earth on May 2022. Lastly, the semi-quantitative risk assessment method was utilized to describe the risk from the perspective of consequences for life and health, the environment, property, and speed of development. Our disaster risk assessment found more than 1 million people (1,187,240 people) in Donetsk Oblast and more than 350 thousand people (353,716 people) in Luhansk Oblast are exposed to potential hazards from the chemical facilities clusters. The aggregation risk of bombardment of chemical facilities cluster in Eastern Ukraine is also high due to ongoing war. Therefore, the chemical industry disaster risks for Eastern Ukraine during complex emergencies in Donetsk Oblast and Luhansk Oblast are high in terms of likelihood and consequences to life and health, environment, property, and speed of development.

Ethical dilemmas affect several essential elements of humanitarian aid, such as the adequate selection of crises to which to provide aid and a selection of beneficiaries based on needs and not political or geostrategic criteria. Other challenges encompass maintaining neutrality against aggressors, deciding whether to collaborate with governments that violate human rights, and managing the allocation and prioritization of limited resources. Additionally, issues arise concerning the safety and protection of aid recipients, the need for cultural and political sensitivity, and recognition of the importance of local knowledge, skills, and capacity. The appropriateness, sustainability, and long-term impact of actions; security risks for aid personnel; and the need for transparency and accountability are also crucial. Furthermore, humanitarian workers face the duty to report and engage in civil activism in response to human rights violations and the erosion of respect for international humanitarian law. Lastly, the rights of affected groups and local communities in the decision-making and implementation of humanitarian aid are vital. The traditional foundations and approaches of humanitarian aid appear insufficient in today’s landscape of disasters and crises, which are increasingly complex and divergent, marked by a diminished capacity and shifting roles of various actors in alleviating suffering. This article reviews the historical evolution of the conceptualization of humanitarian aid and addresses some of its ethical challenges and dilemmas.

Background Emergency medical technicians (EMTs) are essential health care workers (HCWs). Although they play an extraordinary role during the COVID-19 pandemic, they are mostly exposed to various occupational health and safety risks that have significantly impacted their mental health, giving rise to symptoms, such as stress and burnout.Aim This study aimed to assess the perceived levels of stress and burnout amongst EMTs in relation to their socio-demographic characteristics and to explore the associations between their stress and burnout levels during the COVID-19 pandemic.Methods This work is an observational cross-sectional design study conducted between 29 March and 30 April 2021, with a convenience sample of 280 Spanish EMTs yielding a response rate of 28%. The online survey had 42 items that aimed to determine participants’ socio-demographic characteristics, the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory (MBI).Results The results showed that more than half of the EMTs (53%) perceived a moderate stress level, 37% perceived moderate levels of emotional exhaustion (EE) and 40% had moderate levels of depersonalization (DP). Furthermore, 48% had low levels of personal accomplishment (PA). Gender, age, having personal protective equipment (PPE) and experiencing fear of infection were statistically significant areas where participants experienced greater stress (p

Sub-Saharan Africa (SSA) has a rapidly growing urban population, with water, sanitation, and hygiene (WASH) services representing the central needs for this population. Incidentally, this region has the lowest global WASH coverage. Data from the ‘WHO/UNICEF Joint Monitoring Programme for Water supply, Sanitation and Hygiene’ and the ‘Global Burden of Disease’ study from the Institute for Health Metrics and Evaluation were used to assess WASH coverage and related health burden in SSA, its subregions, and rural and urban areas in SSA. WASH coverage in the SSA region appears to be low, but urban coverage is better than that in rural areas; however, there is unequal access to urban WASH and poor urban areas are underserved. In addition, 7.75% (5.99–9.7%) of total deaths due to diarrheal diseases across SSA are attributed to unsafe WASH with a risk factor attribution (RFA) percentage of 95.93% (91.94–98.24%). Therefore, a correlation between WASH coverage and mortality due to diarrheal diseases could be established.There is a lack of data on WASH coverage in poor urban areas, although these areas have high incidence of WASH-related diseases including diarrhea. Disaggregated urban WASH data are needed to better understand the WASH service needs of poor urban areas, which would be helpful in ensuring a more inclusive implementation of WASH services.

Dynamic complexity is often a characteristic of public health issues; to visualize these problems as a system rather than isolated elements, system dynamics modeling may be an appropriate tool.The dynamic complexity of risk factors for lymphatic filariasis (LF) as an urban vector-borne disease has been addressed using system dynamics methodology. Some causal loop diagrams (CLDs) were designed to display the network of interactions of risk factors for urban transmission of LF and a potential set of public health interventions. A stock and flow diagram was also designed to capture the transmission dynamics as an accumulation and flow system, and a simulation model was built and executed.The system dynamics (SD) methodology is suitable for addressing the dynamic complexity of risk factors for LF in urban settings and is well-suited for public health interventions.

The sub-Saharan region of Africa is rapidly urbanizing, that has consequently spurred the development of specific challenges in terms of access to basic services and sanitation. Thus, exposure to waterborne diseases, including cholera, has been a recurrent problem for the people residing in these urban locations. It is important to understand the different risks faced by people in urban areas as it might aid in preventing and controlling the spread of the disease.A review of literature was conducted, using specific selection criteria to obtain relevant publications that described the risk factors for cholera outbreak in urban areas of sub-Saharan Africa.A perusal of available literature indicated that despite the heterogeneity in the urban areas of Africa, there are similarities with respect to the risk factors associated with the incidence of cholera epidemics. These risk factors include geographical location, hydroclimatic parameters, urban environment, genomics of the Vibrio cholerae virulence, sanitation, and human behavior.A succinct comprehension of the possible relationship between the different risk factors might prove to be helpful in managing the cholera epidemic.

The sub-Saharan African region is increasingly becoming urbanized with the creation of an urban ecology that is conducive to the emergence of vector-borne diseases, such as Aedes-borne viral infections. Aedes-borne viral infections pose a threat to urban health in sub-Saharan Africa. The major menacing arbovirus diseases in sub-Saharan Africa include dengue, yellow fever, chikungunya, and Zika, since they have shown (re)emergence in the last decades. In this review, we analyzed the risk factors for the resurgence of these arboviral diseases as well as their epidemiology and burden by studying the literature. The results suggested that the risk of emergence of Aedes-borne viral infections was related to the urbanicity and competence of Aedes, the genetics of these viruses, environmental factors, and the socio-economic conditions of the sub-Saharan population in urban areas. Better public health awareness and appropriate epidemiological and vector surveillance are essential.

Sub-Saharan African countries, like many other low-income countries, have experienced urban socioeconomic inequalities due to rapid and unplanned urbanization. These processes have resulted in the creation of poor urban areas lacking basic sanitation, water, and hygiene facilities, and subjacent public health issues such as the spread of waterborne diseases. A system for the demarcation of disease transmission areas already exists, but the traditional framework is less appropriate in sub-Saharan Africa, making it necessary to divide these urban areas more adequately. In addition, the construction of frameworks and tools more specific to waterborne disease-related issues is essential. We propose restructuring sub-Saharan urban areas into more specific areas of exposure to waterborne diseases and associated exposomes, and then use this restructuring of urban areas of exposure to waterborne diseases in a conceptual framework that takes into account causes of exposure, impacts, and interventions. The division of urban areas into public, domestic, and individual exposure areas facilitates a more straightforward understanding of the dynamics of waterborne exposomes. Moreover, the inclusion of this division in the driving force–pressure–state–exposure–effect–action framework allows an effective stratified implementation of urban public health policies.

Resumen: Objetivo: Estimar la formación recibida y el grado de conocimiento teórico y de habilidad práctica autopercibidos por los enfermeros de Atención Primaria de Salud (APS) de Asturias sobre 40 procedimientos de urgencia, así como sus características. Método: Estudio transversal en una muestra aleatoria y representativa de 236 enfermeros obtenida sobre el total de enfermeros de APS de Asturias (nivel de confianza del 99%) mediante una encuesta estructurada y autoadministrada, elaborada ad hoc y previamente evaluada. Resultados: Los enfermeros perciben tener un conocimiento teórico general de los procedimientos de urgencia de nivel medio (6,39 sobre 10; desviación estándar = 1,56), así como una habilidad práctica general también de nivel medio (6,50 sobre 10; desviación estándar = 1,46) con diferencias significativas (p < 0,05) entre los distintos procedimientos y áreas de salud. Algunos procedimientos muy relevantes en urgencia como la canalización de vías venosas, soporte vital básico o uso de desfibriladores tenían tanto un nivel de conocimiento teórico como de habilidad práctica significativamente bajos (p < 0,05). Discusión: Existen diferencias significativas, tanto a nivel teórico como práctico, en los conocimientos específicos de cada uno de los procedimientos. Mayoritariamente, se percibe tener un mejor grado de conocimiento teórico que de habilidad práctica para atender situaciones de urgencia. Es por ello necesario que la administración sanitaria asegure una homogeneidad adecuada en los niveles de conocimiento teórico y de habilidad práctica de su personal de enfermería. Abstract: Objective: To estimate the formation and the self-perceived level of theoretical knowledge and practical skills of Primary Health Care (APS) of Asturias in 40 procedures of Emergency Medicine, as well as its characteristics. Method: Cross-sectional study of a randomized and representative sample of 236 nurses (n) on the total of 730 APS nurses (N) of Asturias on MUE procedures using a structured questionnaire in 2 dimensions, ad hoc and previously evaluated. Results: The nurses perceive to have a general theoretical knowledge of the procedures of urgency and emergency of average level (6,39 on 10; standard deviation = 1,56), as well as a general practical skill also of average level (6,50 on 10; standard deviation = 1,46) with significant differences (p

The COVID-19 pandemic has shocked health systems worldwide, with visible impacts on intensive care units and emergency departments. The concept of “surge capacity” should be analyzed within this context as this crisis could be seen as an opportunity to improve the knowledge base of intensive care units and emergency departments.We reflected, based on our experience from work at the frontlines, on health service planning and with epidemiological data, about the importance of surging critical care capacity for COVID, now and as lessons for the future. We summarize and relate virus clinical characteristics, epidemiological patterns and critical care surge capacity as important factors to consider for effective health systems response. Some practical aspects are described, but also the role that mathematical models can play to improve intensive care units surge capacity by considering its importance as a predictor of needs according to epidemiological patterns. Also, in the transitional phase, we consider the importance of coexisting COVID-19 and non-covid-19 health care services, and the importance of a new surge capacity for postponed activities. In this new transitional phase, also emergency departments will have to adapt their surge capacity for a rebound effect due to delayed visits from non-COVID-19 health conditions during the pandemic.Health systems and society must remain vigilant for potential resurgence of cases as measures are relaxed to restart the economy and a new normal. Emergency departments and intensive care units have to develop surge strategies to deal together with COVID-19 and non-COVID-19 flow of patients.

Resumen: Objetivo: Conocer la formación recibida por los médicos de atención primaria de salud (APS) de Asturias y estimar su grado de conocimiento teórico y habilidad práctica autopercibida en 49 procedimientos de medicina de urgencia y emergencia (MUE). Método: Estudio observacional de corte transversal de una muestra aleatoria y representativa de 213 médicos (n) sobre los 851 médicos (N) de la plantilla de APS de Asturias acerca de procedimientos de MUE mediante un cuestionario estructurado en 2 dimensiones. Resultados: La formación recibida en MUE se percibe de nivel medio (6 sobre 10), el conocimiento teórico general es de nivel medio (5,9 sobre 10), con diferencias significativas según el procedimiento estudiado (rango de 2 a 9 sobre 10). También se percibe como de nivel medio la habilidad práctica general en MUE (media de 5,5 sobre 10). Se percibe tener un mejor grado de conocimiento teórico que de habilidad práctica para actuar en situaciones de urgencia y emergencia. En Asturias el porcentaje medio de adquisición de las competencias en los procedimientos estudiados es bajo (24,87% para conocimientos teóricos y 21,93% en habilidades prácticas) y disminuye con los años trabajados. Conclusiones: La formación en MUE de los médicos de APS en Asturias es heterogénea y percibida como de nivel medio, con deficiencias en procedimientos relevantes. Es necesario que las administraciones sanitarias evalúen adecuada y periódicamente estos conocimientos y habilidades en los médicos para ser capaces de garantizar un nivel de calidad asistencial adecuado a la urgencia y emergencia. Abstract: Objective: To determine the training received by the physicians of Primary Health Care (APS) of Asturias and estimate their self-perceived level of theoretical knowledge and practical skills in 49 procedures Emergency Medicine procedures (MUE). Method: A cross-sectional study was conducted on a randomised and representative sample of 213 physicians (n) from the total of 851 APS physicians (N) of Asturias on MUE procedures using a structured questionnaire in two dimensions. Results: Training received in MUE is perceived as medium level (6 out of 10), general theoretical knowledge as intermediate level (5.9 out of 10), with significant differences according to the procedure studied (range 2 to 9 out of 10). General practical skills in MUE are also perceived as average level (mean of 5.5 out of 10). It is perceived to have a better level of theoretical knowledge than practical ability to face emergency situations. In Asturias the mean percentage of acquisition of competences in the procedures studied is low, (24.87% for theoretical knowledge and 21.93% for practical skills) and decreases with the years employed. Conclusions: Education in MUE of APS physicians in Asturias is heterogeneous, and is perceived as average level, with deficiencies in relevant procedures. Health administrations need to adequately and periodically evaluate this knowledge and skills in physicians to be able to guarantee the level of quality emergency healthcare. Palabras clave: Emergencias, Atención primaria de salud, Percepción, Conocimiento, Keywords: Emergencies, Primary health care, Perception, Knowledge

Fundamentos. Las emergencias complejas son situaciones de violencia, inseguridad nutricional y desplazamiento poblacional, de frecuencia e intensidad crecientes y que plantean un problema grave de salud pública a las poblaciones afectadas. Las enfermedades transmisibles, especialmente las hídricas como el cólera, causan hasta el 75% de la morbi-mortalidad en emergencias complejas. El objetivo es analizar las epidemias de cólera en emergencias complejas y los factores de riesgo asociados a la emergencia. Métodos. Estudio descriptivo que analiza las epidemias de cólera en emergencias complejas en países afectados entre 2000 y 2011, mediante revisión de la información publicada formalmente, como la correspondiente a informes de terreno no publicados por las organizaciones y agencias de ayuda. Se utilizaron indicadores de incidencia, mortalidad y letalidad. Resultados. La incidencia anual media del cólera en zonas de emergencia compleja fue de 1,2 por 1.000 habitantes (IC95% = 0,5 - 1,9) y la letalidad media de las epidemias fue del 4,08 % (IC95% = 3,3 - 4,86). Conclusiones. En los casos estudiados están presentes factores de riesgo específicos de las emergencias complejas que amplifican los impactos del cólera, como deficiencias graves en agua y saneamiento, hacinamiento, debilidad del sistema sanitario, falta de inmunidad previa de la población afectada e introducción o reintroducción del agente causal.

El terrorismo es hoy un problema de distribución global e interés creciente para la salud pública internacional. La violencia que comporta afecta a la salud pública y los servicios sanitarios de manera importante y en diferentes ámbitos, entre ellos, aumenta la mortalidad, morbilidad y discapacidad, genera un contexto de miedo y ansiedad que hace muy frecuentes los trastornos psicopatológicos, altera gravemente el funcionamiento de los servicios sanitarios y produce importantes daños sociales, políticos y económicos. Estos efectos son, además, especialmente intensos cuando el fenómeno se produce de manera crónica en una comunidad. El objetivo de este trabajo es examinar la relación entre terrorismo y salud pública, particularmente en cuanto a sus efectos sobre esta y sobre los servicios sanitarios, así como examinar los posibles marcos de abordaje del terrorismo como problema de salud pública, con especial referencia a la situación en España. Frente a este problema, tanto los sistemas de salud pública como los servicios sanitarios, deberían adaptar sus enfoques y funcionamiento especialmente en seis ámbitos prioritarios relacionados con: (1) La coordinación entre las diferentes agencias de respuesta sanitaria y no sanitaria; (2) El refuerzo de los sistemas de vigilancia epidemiológica; (3) La mejora de las capacidades de los laboratorios de salud pública y de los sistemas de respuesta sanitaria a tipos específicos de terrorismo como son el terrorismo químico o biológico; (3) Los servicios de salud mental; (4) La planificación y coordinación de la respuesta de emergencia de los servicios sanitarios; (5) Las relaciones con la población y los medios de comunicación y, finalmente; (6) Una mayor transparencia en la difusión de la información y un mayor grado de análisis de las acciones sanitarias llevadas a cabo en el ámbito de la respuesta de emergencia.

Objetivos: Seleccionar y estudiar la aceptabilidad, en términos de relevancia y pertinencia, de ciertas situaciones clínicas que puedan usarse como indicadores de riesgo de morbilidad prevenible causada por medicamentos y que sean utilizables en las farmacias comunitarias. Método: Método Delphi, en 2 rondas, con un panel de 14 expertos médicos y farmacéuticos que valoraron la relevancia y pertinencia de 68 tipos de situaciones clínicas como indicadores de morbilidad potencial relacionada con medicamentos, detectable por el profesional en su medio, con evidencia científica de resultado adverso previsible, frecuentes en el medio ambulatorio y con causa y resultado controlables. Resultados: Se consideraron utilizables y pertinentes 43 de los 68 indicadores estudiados, que se referían a 3 ámbitos: tipo de medicamento (medicamentos de estrecho margen terapéutico, con dosis individualizada y con reacciones adversas frecuentes y graves), problema de salud (problemas crónicos, especialmente asma, enfermedad cardíaca, tiroidea, prostática y dolor) y tipo de paciente (ancianos y/o polimedicados). Los farmacéuticos sobrevaloraron sistemáticamente ciertos indicadores en relación con los médicos, aunque las diferencias no fueron significativas. Conclusiones: Se identificaron 43 indicadores de morbilidad potencial relacionada con los medicamentos e identificables por los profesionales en su entorno.Objective: To select clinical situations that can be used as risk indicators of preventable morbidity caused by drugs at the community pharmacies, and to study their acceptability, in terms of pertinence and relevance. Methods: We used the Delphi technique, in 2 rounds, by a panel of 14 medical doctors and pharmacists experts, to study the relevance of 68 types of clinical situations as risk indicators of preventable morbidity related to drug utilization used by health professionals in community pharmacies, with scientific evidence of foreseeable adverse result, frequent situations in ambulatory care and with controllable cause and result. Results: 43 of the 68 indicators were considered usable and pertinent. The indicators referred three areas: drug type (medications of narrow therapeutic margin, with individualized dose and adverse reactions frequent and severe), health problem (chronic problems, especially asthma, cardiac, thyroid and prostate illness, and pain), and patient (old or with several medications. Pharmacists systematically overvalued some indicators in relation to the doctors, but differences were not significant. Conclusions: Forty-three indicators were selected as valuable to identify situations of preventable morbidity related to drug utilization.

Objetivo: Este estudio analiza los episodios de desastres ocurridos en España entre 1950 y 2005, para conocer su distribución y estimar su impacto en la mortalidad y la morbilidad. Métodos: Estudio observacional retrospectivo en el que se ha utilizado la definición de Naciones Unidas y se ha considerado desastre al episodio, natural o tecnológico, con más de 15 muertos y/o más de 50 heridos, excluidos los desastres medioambientales y los fenómenos epidémicos. Resultados: La frecuencia de desastres en España ha aumentado durante el período estudiado, especialmente en las últimas 4 décadas, y son el doble en el segundo semestre del año, con una gran variabilidad geográfica. España tiene un perfil de desastre mixto, con predominio de los desastres tecnológicos, que son 4,5 veces más frecuentes que los naturales. El desastre natural más frecuente en nuestro país es la inundación y el tecnológico, el accidente de tránsito.Objective: To analyze disaster episodes in Spain between 1950 and 2005 in order to characterize their pattern and evaluate their impact on morbidity and mortality. Methods: We performed an observational retrospective study using the United Nations' definition of disaster. A disaster was considered as each episode, natural or technological, causing more than 15 deaths and/or more than 50 wounded persons. Epidemic and environmental disasters were excluded. Results: The frequency of disasters has increased in Spain, especially during the four last decades. The frequency of disasters doubles in the second semester of the year and shows wide geographical variation. Spain has a mixed disaster pattern, with a predominance of technological disasters, which are 4.5 times more frequent than natural disasters. The most frequent type of natural disaster in Spain is flooding and most frequent technological disasters are traffic accidents.

Fundamento: Este estudio valora los efectos de un nuevo modelo de trabajo en las farmacias, denominado Atención Farmacéutica, frente al modelo tradicional. Se pretende conocer su factibilidad y las diferencias, potencialmente debidas a la Atención Farmacéutica, respecto de los resultados de salud de la farmacoterapia usada, en una muestra de pacientes que han sufrido episodios coronarios agudos. Métodos: Es un estudio prospectivo con un grupo de intervención (330 personas) y un grupo control (405 personas), realizado en 83 farmacias de Asturias, Barcelona, Madrid y Vizcaya, en las que se hizo seguimiento durante un año del uso de medicamentos en 735 personas, de las cuales finalizaron el estudio 600. Resultados: Hubo diferencias favorables al grupo intervención, respecto de: a) uso de servicios sanitarios indicativos de mayor morbilidad, tales como la frecuencia de consultas hospitalarias urgentes por paciente 1,27Interv. (IC95 %:1,10 a 1,44) y 1,63Contr.(IC95 %:1,36 a 1,90) o los días promedio de UCI por paciente hospitalizado: 2,46Interv.(IC95 %:1,56 a 3,36) y 5,87Contr.(IC95 %: 3,57 a 8,17), por causa cardiológica; b) calidad de vida con diferencia de 4,7 (p < 0,05) en la dimensión de función física; c) conocimiento de factores de riesgo de enfermedad coronaria, promedio de +10 % (p < 0,02 - 0,07, según dimensión); d) identificación nominal de los medicamentos usados +10 % (p < 0,01); importancia subjetiva otorgada a los antiagregantes + 12 % (p < 0,009), los beta-bloqueantes, así como sus efectos +25 % (p < 0,02); y e) satisfacción con la AF y percepción de la competencia profesional, promedio de + 12 % (p < 0,000 0,05, según dimensión). Conclusiones: Los valores menores de: demanda individual urgente coronaria, frecuencia de hospitalizaciones y número de días de Unidad de Cuidados Intensivos coronaria por hospitalización, sugerirían que los pacientes que tras un episodio coronario agudo reciben Atención Farmacéutica tienden a estar menos enfermos en los doce meses del seguimiento realizado. Bajo el modelo de Atención Farmacéutica los pacientes conocen mejor las razones de su farmacoterapia y, por ello, utilizan mejor los servicios sanitarios del sistema, alcanzando un mayor nivel de salud.