Ana López de Andrés

Influenza vaccination coverages among children, adults, health care workers and immigrants in Spain: Related factors and trends, 2003–2006

OBJECTIVESnThis study sought to: describe influenza vaccination coverage among Spanish children, adults, health care workers (HCWs), and immigrants according to the 2006 Spanish National Health Survey (NHS); and analyze the time trend for the period 2003-2006.nnnMETHODSnWe analyzed 38,329 questionnaires drawn from the 2006 NHS, covering subjects aged 6 months and over. As the dependent variable, we took the answer to the question, Did you (or your child) have a flu shot in the last campaign?. Independent variables were age group, gender, nationality, occupation (HCWs), and coexistence of chronic conditions.nnnRESULTSnIn 2006, vaccination coverage for the Spanish population was: 22.2% overall; 6.8% for all children; and 19.1% for children with a chronic medical condition. Coverages were: 66.8% among subjects aged >/=65 years; 26.6% among high-risk subjects aged <65 years; and 24.2% among HCWs. A significantly lower proportion of immigrants reported vaccination than did indigenous subjects. After controlling for possible confounders, the likelihood of having been vaccinated in 2006 was lower than in 2003 for the entire population (adjusted OR 92, 95%CI 0.86-0.97). In specific target groups, however, coverage underwent a significant reduction from 2003 to 2006 among high-risk subjects aged 16-64 years, and immigrants. Significant improvements were found among subjects aged over 64 years, and children.nnnCONCLUSIONSnAvailable data show unacceptably low levels of influenza vaccination coverage among high-risk subjects aged under 65 years, children with chronic medical conditions, and HCWs. A special effort is thus called for to implement strategies that have demonstrated their effectiveness in enhancing vaccination coverages.

Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality

BackgroundHip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients undergoing primary total hip arthroplasty (THA) over an 8-year study period in Spain.MethodsWe selected all surgical admissions in individuals aged ≥40 years who had received a primary THA (ICD-9-CM procedure code 81.51) between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index.Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM.ResultsWe identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p < 0.001). In 2001, 81% of patients had a Charlson Index of 0, 18.4% of 1-2, and 0.6% > 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p < 0.001). The mean LOHS was 13 days in 2001 and decreased to 10.45 days in 2008 (p < 0.001). During the period studied, the mean cost per patient increased from 6,634 to 9,474 Euros. Multivariate analysis shows that from 2001 to 2008 the incidence of THA hospitalizations has significantly increased for both sexes and only men showed a significant reduction in IHM after THA.ConclusionsThe current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.

Trends in hospital admissions for acute exacerbation of COPD in Spain from 2006 to 2010

OBJECTIVEnWe aim to analyze changes in incidence, comorbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) over a 5-year study period in Spain.nnnMETHODSnWe selected all hospital admissions for AE-COPD between 2006 and 2010 from the National Hospital Discharge Database covering the entire population of Spain.nnnRESULTSnWe identified a total of 215,835 patients. Overall crude incidence had decreased from 2.9 to 2.4 exacerbations of COPD per 10,000 inhabitants from 2006 to 2010 (p < 0.001). In 2006, 17.9% of patients had a Charlson Index >2 and in 2010, the prevalence had increased to 25.0% (p < 0.001). Regarding to treatment, we detected a significant increase in the use of non-invasive ventilation from 2.1% in 2006 to 5.3% in 2010 (p < 0.001). The median LOHS was 7 days in 2006 and it remained stable until 2010. During the period studied, the mean cost per patient increased from 3747 to 4129 Euros. Multivariate analysis showed that incidence of hospitalizations for AE-COPD and IHM had significantly decreased from 2006 to 2010.nnnCONCLUSIONSnThe current study provides data indicating a decrease in incidence of hospital admissions for AE-COPD in Spain from 2006 to 2010 with concomitant reduction in IHM, despite increasing comorbidity during this period, with no variations in LOHS. The mean cost per patient has risen significantly.

Gender influence in influenza vaccine uptake in Spain: time trends analysis (1995-2006).

This study aims to analyze gender differences in influenza vaccine coverage and predictors of vaccine uptake in Spain from year 1995 to 2006. We used data obtained from the Spanish National Health Surveys (NHSS) conducted in 1995, 1997, 2001, 2003 and 2006. Only subjects for whom the vaccine was recommended in Spain (age >or=65 years and <65 years with an associated chronic condition) during the entire study period were analyzed. Influenza vaccination status was self-reported. Independent variables included: year of survey, age, marital status, educational level, size of town, physician visits and chronic conditions. The study population included 26,653 (15,973 women and 10,680 men) individuals and 54.9% (CI 95% 54.3-55.5) were vaccinated. Vaccination coverage was higher among men than women in each and all of the NHSS analyzed. Positive predictors of vaccine uptake were the same among women and men including: higher age, being married, lower educational level, Physician visits in last four weeks; and the presence of associated chronic condition. Time trends 1995/1997-2006 showed that the coverage has improved for women (OR 1.12 CI 95% 1.09-1.16) and men (OR 1.11 CI 95% 1.06-1.15). Over the whole study period men had 12% greater probability of having received the vaccine. We conclude that in Spain there are significant gender differences in influenza vaccine uptake with lower coverage among women. These differences have remained throughout all years studied. We suggest that possible explanations for the lower uptake among women could include less social support, differences in the health status and provider bias.

Awareness and uptake of colorectal, breast, cervical and prostate cancer screening tests in Spain

BACKGROUNDnWe aim to describe levels of awareness and uptake of colorectal, breast, cervical and prostate cancer screening tests and to analyze the association to socio-demographic and health-related variables.nnnMETHODSnPopulation-based cross-sectional study conducted using a home-based personal interview survey on a nationwide representative sample (n = 7938) of population aged ≥18 years (Oncobarometro Survey). Awareness was assessed by asking participants: Now I am going to mention several medical tests for cancer detection, please tell me if you already know about them or if this is the first time you have heard of them? The tests mentioned were faecal occult blood test (FOBT), mammography, Pap smear and prostate-specific antigen (PSA). Cancer screening uptake was assessed by asking participants whether they had received tests within the previous 2 years.nnnRESULTSnAwareness rates of 38.55% for FOBT, 95.03% for mammography, 70.84% for Pap smears and 54.72% for PSA were found. Uptake mammography was 74.46%, Pap smears 65.57%, PSA 35.19% and FOBT 9.40%. Factors such as immigration status, lower educational level or income and not suffering from chronic conditions are negative predictors for uptake.nnnCONCLUSIONSnAwareness and uptake results showed acceptable figures for mammography, moderate for Pap smears and unacceptably low for FOBT. Inequalities exist in uptake of cancer screening. It is necessary to develop public health educational programmes, especially for the vulnerable populations, aiming to inform and motivate them to use screening services on a regular basis. Our data suggest that although PSA is not recommended, this opportunistic screening is frequently used in Spain.

Psychological distress and mental disorders among Spanish diabetic adults: A case-control study

AIMnTo compare the prevalence of psychological distress and mental disorders between diabetes and non-diabetes sufferers and to identify associated factors.nnnMETHODSnCase-control study based on data from the 2006 to 2007 Spanish National Health Survey. We identified 2193 type 2 diabetic adults. Non-diabetic controls were 1:1 matched by age-and-sex. The presence of a mental disorder was considered if subjects answered yes to the questions: Have you suffered depression and/or anxiety over the previous 12 months? AND Has your medical doctor confirmed the diagnosis?. The 12-item General Health Questionnaire was used to measure psychological distress. Independent covariables included socio-demographics and heath related variables.nnnRESULTSnPrevalence of mental disorders was 18.6% among diabetics and 16.4% among controls (adjusted OR 1.17 CI 95% 1.01-1.38). 26% of diabetics and 18.9% of the non-diabetic suffered psychological distress (adjusted OR 1.51 CI 95% 1.25-1.83). Among diabetics variables associated with suffering a mental disorder and psychological distress were: female sex, younger age, worse self rated health, comorbidity, GP visit in the last 4 weeks and ER attendance in last year.nnnCONCLUSIONSnDiabetic adults have significantly higher prevalence of diagnosed mental disorders and psychological distress than non-diabetic subjects. Programs targeted at preventing, monitoring and controlling these mental health problems at primary care should be implemented.

Effectiveness of Standardized Nursing Care Plans in Health Outcomes in Patients with Type 2 Diabetes Mellitus: A Two-Year Prospective Follow-Up Study

Background Implementation of a standardized language in Nursing Care Plans (SNCP) allows for increased efficiency in nursing data management. However, the potential relationship with patientś health outcomes remains uncertain. The aim of this study was to evaluate the effectiveness of SNCP implementation, based on North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classification (NIC), in the improvement of metabolic, weight, and blood pressure control of Type 2 Diabetes Mellitus (T2DM) patients. Methods A two-year prospective follow-up study, in routine clinical practice conditions. 31 primary health care centers (Spain) participated with 24,124 T2DM outpatients. Data was collected from Computerized Clinical Records; SNCP were identified using NANDA and NIC taxonomies. Descriptive and ANCOVA analyses were conducted. Results 18,320 patients were identified in the Usual Nursing Care (UNC) group and 5,168 in the SNCP group. At the two-year follow-up, the SNCP group improved all parameters except LDL cholesterol and diastolic blood pressure. We analyzed data adjustming by the baseline value for these variables and variables with statistically significant differences between groups at baseline visit. Results indicated a lowering of all parameters except HbA1c, but a statistically significant reduction was only observed with diastolic blood pressure results. However, the adjusted reduction of diastolic blood pressure is of little clinical relevance. Greater differences of control values for diastolic blood pressure, HbA1c, LDL-cholesterol and Body Mass Index were found in the SNCP group, but only reached statistical significance for HbA1c. A greater proportion of patients with baseline HbA1c ≥7 decreased to <7% at the two-year follow-up in the SNCP group than in the UNC group (16.9% vs. 15%; respectively; pu200a=u200a0.01). Conclusions Utilization of SNCP was helpful in achieving glycemic control targets in poorly controlled patients with T2DM (HbA1c ≥7%). Diastolic blood pressure results were slightly improved in the SNCP group compared to the UNC group. Trial Registration ClinicalTrials.gov NCT01482481

Coverage and predictors of influenza vaccination among adults living in a large metropolitan area in Spain: a comparison between the immigrant and indigenous populations.

This study sought to evaluate influenza vaccination coverage in Madrid (Spain). Coverages were estimated for vaccine target groups and special attention was placed on the immigrant population. Individual data from 7341 adults included in the Madrid City Health Survey conducted in 2005 was used. Overall influenza vaccination coverage was 24%. Compliance with age-based influenza vaccine guidelines (>or=65 years) was 63.9%, among those<65 years who had an associated chronic condition, it was 37.9% and 24.1% among HCWs. Immigrants accounted for 12.4% of the sample. Overall crude coverage was significantly lower among immigrants than among the indigenous population (11.2% vs. 25.9%), but once the multivariate analysis had been performed, the association became non-significant. In conclusion, it must be said that all the available evidence indicates an inadequate level of influenza vaccination coverage among HCWs and high-risk subjects <65 years. On the other hand, coverages among subjects aged >or=65 years are acceptable and there is no observable difference in vaccine use between immigrants and indigenous subjects. Strategies that have demonstrated their effectiveness in enhancing vaccination coverages should be applied in Madrid.

Trends in cardiovascular risk factors and lifestyle behaviors among Spanish adults with diabetes (1993-2003).

UNLABELLEDnPrevious studies have observed high prevalences of high blood pressure (HBP), high blood cholesterol (HBC), obesity, and sedentary lifestyle among Spanish diabetic adults. These cardiovascular risk factors and unhealthy lifestyle behaviors occur more often in subjects with diabetes than in the general population. The aim of this study was to examine the trends in cardiovascular risk factors and lifestyle behaviors among Spanish adults with diabetes over the decade 1993-2003.nnnMETHODSnWe used individualized data drawn from the 1993 (N=20,880) and 2003 (N=21,650) Spanish National Health Surveys. Subjects were classified as diabetes sufferers if they answered affirmatively to either or both of the following questions: Has your doctor told you that you are currently suffering from diabetes? and/or, Have you taken any medication to treat diabetes in the last two weeks? Cardiovascular risk factors analyzed included self-reported HBP and HBC. Lifestyle behaviors included obesity (body mass index >or=30), smoking status, and physical activity. We estimated and compared the prevalences and analyzed the time trends using logistic regression models.nnnRESULTSnIn both years studied, the prevalence of obesity and sedentary lifestyle was significantly higher among persons with than among those without diabetes, and current smoking was less frequent. The proportions of diabetes patients with HBP and obesity increased significantly from 39.5% and 20.1% in 1993 to 46.7% and 29.8% in 2003, with adjusted odds ratios of 1.32 (95% CI 1.07-1.62) for HBP and 1.88 (95% CI 1.44-2.46) for obesity.nnnCONCLUSIONSnThe overall prevalence of cardiovascular risk factors and unhealthy lifestyle behaviors among diabetes patients has shown no improvement in the decade 1993-2003, and there have been significant setbacks, in particular the rise in obesity and HBP.

National trends in hospital admissions for asthma exacerbations among pediatric and young adult population in Spain (2002-2010).

OBJECTIVEnTo assess the changes in incidence, use of mechanical ventilation, length of stay (LOS), costs and mortality of children (0-15 years) and young adults (16-45 years) hospitalized for asthma exacerbations.nnnMETHODSnWe included patients hospitalized for asthma exacerbations in Spain from 2002 to 2010 (ICD9-CM codes 493.0x-493.9x). The data were collected from the National Hospital Discharge Database (entire population). We calculated the yearly age- and sex-specific incidence rates for each of the two groups.nnnRESULTSnWe included a total of 12,038 pediatric patients and 2792 young adults hospitalized for asthma exacerbations. Overall crude incidence decreased from 20.5 to 18.7 admissions per 100.000 inhabitants in the pediatric group (pxa0<xa00.05), and from 4.12 to 3.68 admissions per 100.000 inhabitants among young adults, from 2002 to 2010 (pxa0<xa00.05). By contrast, we detected a significant increase in the use of non-invasive ventilation (NIV) in both groups. The average LOS decreased during the study period, from 3.71 (SD 2.28) to 3.16 (SD 2.11) days (pxa0<xa00.05) among pediatric patients and there were not changes among young adults. During the study period, the mean cost per patient decreased from 1558.53 (SD 443.63) to 1378.41 (SD 472.71) euros in the pediatric group (pxa0<xa00.05), while increased from 2183.44 (SD 783.15) to 2564.32 (SD 1933.98) euros among young adults (pxa0<xa00.05).nnnCONCLUSIONnOur results suggest a decrease in the incidence of hospital admissions for asthma exacerbations with concomitant increase in use of NIV in asthmatic patients, both pediatric and young adults patients. Although LOS and mean cost have decreased among pediatric patients, they have not changed and increased, respectively, among young adults. A better management of the disease at primary care services may explain the improvement in the incidence and outcomes.