Clara Bermúdez-Tamayo

Características organizativas de la atención primaria y hospitalización por los principales ambulatory care sensitive conditions

Objetivos. a) Describir la variabilidad en las tasas de hospitalizacion por los ambulatory care sensitive conditions (ACSC) mas frecuentes, por municipio y sexo; b) analizar la influencia de las caracteristicas de la atencion primaria (modelo reconvertido/no reconvertido y tipo de centro), el nivel de salud de la poblacion, la accesibilidad geografica y otros factores de caracter socioeconomico sobre dichas tasas. Diseno. Estudio observacional y transversal para el estudio de las altas hospitalarias y ecologico para el analisis de las tasas entre municipios. Mediciones principales. Se calcularon las tasas de hospitalizacion por sexos para cada ACSC (1997-1999), se estandarizaron por edad segun el metodo indirecto y se calcularon las razones estandarizadas de tasas (RET). El analisis multivariante se realizo mediante el test de regresion de Poisson. Resultados. El 41% de los municipios tuvo igual numero de casos observados y esperados de hospitalizacion en los varones y el 65% en las mujeres, para los diagnosticos estudiados. La enfermedad pulmonar obstructiva cronica en los varones y el fallo cardiaco en las mujeres fueron los procesos con una mayor variabilidad. Las tasas de hospitalizacion por la mayoria de los procesos fueron mas elevadas en municipios sin centro de salud o modelo no reconvertido, con mas de 3.000 habitantes y mas cercanos al hospital, si bien la distancia al hospital solo influyo en los municipios grandes. Conclusiones. a) Se observa variabilidad entre municipios en las tasas de hospitalizacion por los ACSC mas frecuentes, y b) las diferencias en las tasas de hospitalizacion por los ACSC estudiados se asocian con caracteristicas organizativas de la atencion primaria, el tamano del municipio y la distancia al hospital.

Use of the internet as a source of health information by Spanish adolescents

BackgroundThe Internet is a fundamental part of the daily life of adolescents, they consider it as a safe and confidential source of information on health matters. The aims is to describe the experience of Spanish adolescents searching for health information on the Internet.MethodsA cross-sectional study of 811 school-age adolescents in Granada was carried out. An adapted and piloted questionnaire was used which was controlled by trained personnel. Sociodemographic and health variables were included together with those concerning the conditions governing access to and use of information and communication technologies (ICT).Results811 adolescents were surveyed (99.38% response rate), mean age was 17 years old. Of these, 88% used the Internet; 57.5% used it on a daily or weekly basis and 38.7% used it occasionally. Nearly half the sample group (55.7%) stated that they used the Internet to search for health-related information. The main problems reported in the search for e-health were the ignorance of good web pages (54.8%) and the lack of confidence or search skills (23.2%).ConclusionsIn conclusion, it seems plausible to claim that websites designed and managed by health services should have a predominant position among interventions specifically addressed to young people.

Factores asociados a la hospitalización por procesos sensibles a cuidados ambulatorios en los municipios

Objetivos: Describir la variabilidad en las tasas de hospitalizacion por procesos sensibles a cuidados ambulatorios (PSCA) entre municipios del area de referencia de un hospital de tercer nivel, y determinar la influencia de las caracteristicas de la atencion primaria, los factores socioeconomicos, el nivel de salud de la poblacion y la accesibilidad geografica al hospital. Metodo: Se realizo un estudio ecologico en 34 municipios del area del Hospital Virgen de las Nieves (Granada), abarcando todas las hospitalizaciones por PSCA de 1997 a 1999. Las tasas de hospitalizacion se calcularon por separado para varones y mujeres y se estandarizaron por el metodo indirecto segun la edad. Se exploraron como variables independientes las siguientes: caracteristicas de la atencion primaria (tipo de modelo y centro), socioeconomicas (desempleo, renta, comercios, tamano del municipio), de salud (mortalidad) y accesibilidad (crona: minutos desde el municipio al hospital). Se realizo un analisis de regresion lineal multiple. Resultados: El 9,8% de los ingresos ocurridos en el hospital fueron por PSCA. La tasa media anual fue de 10 ingresos por 1.000 habitantes, siendo superior en varones y en los mayores de 74 anos. En el 56% de los municipios las razones de hospitalizacion estandarizadas no fueron estadisticamente diferentes de 1, en un 26% fueron menores y en un 18%, mayores. Un 62% de la variabilidad en las tasas de los varones se explico por la crona al hospital, el tamano del municipio, la interaccion entre ambas variables y la mortalidad. Las tasas en mujeres se explicaron en un 18% por la crona y la tasa de desempleo. Conclusiones: La variabilidad de las tasas de hospitalizacion por PSCA no se asocio a las caracteristicas de la atencion primaria en el ambito geografico estudiado. La mayor accesibilidad en tiempo al hospital fue la unica variable asociada a mayores tasas en varones y mujeres. Las tasas en mujeres fueron superiores cuanto mayor era el desempleo, y las tasas en varones fueron mas altas en los pueblos grandes y con mayor mortalidad.

Information needs and Internet use in urological and breast cancer patients

AimsThis study aims to describe the information needs of urological and breast cancer patients and factors related to use of the Internet as a source of health information.MethodologyA cross-sectional descriptive study was carried out, using individual questionnaire-based interviews held during the oncology appointments of 169 patients with urological cancer and 100 with breast cancer at the Virgen de las Nieves University Hospital in Granada, Spain. The variables studied were use of the Internet as a source of health information, health status, patient’s role in the decision-making process, information sources, satisfaction with the health-care system, type of information received, and Internet use. A multivariate logistic regression analysis was carried out.ResultsBreast cancer patients are more concerned with long-term results and the effects on their family and personal life. They are also interested in the experiences of other patients and support groups or staff who could help them to cope with their illness. The information needs of patients with urological cancer are linked to short-term alternative treatments, their sex life, keeping healthy, and exercise. More clinical aspects, such as tests and experiments linked to their treatment, are not a frequent information need. The factors linked to use of the Internet as a source of health information are younger age, high level of education, the patient’s active role in the decision-making process, and undergoing more aggressive treatment. There is no link between using the Internet as a source of health information and level of satisfaction with the health-care system, or with Internet use in general.ConclusionPatients need additional information about their illness on top of that given to them by health-care staff, and they often use the Internet to find it. The greatest information need is related to the effects of their illness on their day-to-day life. Health-care staff should provide patients with advice about reliable websites and how to search the Internet.

Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS

BackgroundThe epidemic of HIV/AIDS and treatments that have emerged to alleviate, have brought about a shift in the burden of disease from death to quality of life/disability. The aim was to determine which factors are associated with improvements in the level of health of male and female patients with HIV/AIDS in Andalusia, in terms of disability-adjusted life years.MethodsDescriptive study based on a sample group of 8800 people on the Andalusian AIDS register between 1983 and 2004. Dependent variables: Life lost due to premature mortality (YLL), years lost due to disability (YLD) and disability-adjusted life years (DALY). Independent variables: vital state, sex, age at the time of diagnosis, age at the time of death, transmission category, province of residence, AIDS-indicator disease and the period of diagnosis. A bivariate analysis was carried out to find out if the health level variables changed in accordance with the independent variables. Using the independent variables which had a statistically significant link with the level of health variables, a multivariate linear regression model, disaggregated by gender, was constructed.ResultsAmongst the women, we found a model which explained the level of health of 64.9%: a link was found between a higher level of health (lower DALYs) and not intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Amongst the men, we found a model which explained the level of health of 64.4%: a link was found between a higher level of health (lower DALYs) and intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis.ConclusionA higher level of health (lower DALY) amongst both men and women was found to be linked to not be intravenous drug user, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis.

Cost-effectiveness of percent free PSA for prostate cancer detection in men with a total PSA of 4-10 ng/ml.

Objective: To assess the cost-effectiveness of two diagnostic strategies for prostate cancer in men with prostate-specific antigen (PSA) levels of 4–10 ng/ml and normal digital rectal examination (DRE). Design: Cost-effectiveness analysis was performed using a decision tree model. Data collection and a systematic review of patients at the Urology Department (Carlos Haya Hospital) were made. 101 patients over the age of 40 with PSA levels of 4–10 ng/ml and normal DRE were selected. Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and percent free PSA testing prior to TRUS-Bx were performed. The outcome measures used were the incremental cost-effectiveness ratio, and costs were calculated through activity-based costing. The effectiveness was measured by means of the number of detected cases, test utility and actual cases (detected cases minus lost cases). Results: Using base-case analysis, the strategy of percent free PSA + TRUS-Bx was found to be the most cost-effective. The incremental cost-effectiveness ratio for free PSA + TRUS-Bx compared with TRUS-Bx was EUR 2,277.40. Strategy 2 (TRUS-Bx) would be more cost-effective if the cost of percent free PSA increased to EUR 21.64 or if prostate cancer prevalence increased to 26%. Conclusions: The use of percent free PSA prior to TRUS-Bx is the most cost-effective diagnostic strategy. However, this result is very sensitive and strategy 2 (TRUS-Bx) would be more cost-effective if the cost of the percent free PSA increased to EUR 21.64 or if the prevalence of prostate cancer increased to above 26%.

Approach to identifying research gaps on vector-borne and other infectious diseases of poverty in urban settings: scoping review protocol from the VERDAS consortium and reflections on the project’s implementation

BackgroundThis paper presents the overall approach undertaken by the “VEctor boRne DiseAses Scoping reviews” (VERDAS) consortium in response to a call issued by the Vectors, Environment and Society unit of the Special Programme for Research and Training in Tropical Diseases hosted by the World Health Organization. The aim of the project was to undertake a broad knowledge synthesis and identify knowledge gaps regarding the control and prevention of vector-borne diseases in urban settings.MethodsThe consortium consists of 14 researchers, 13 research assistants, and one research coordinator from seven different institutions in Canada, Colombia, Brazil, France, Spain, and Burkina Faso. A six-step protocol was developed for the scoping reviews undertaken by the consortium, based on the framework developed by Arksey and O’Malley and improved by Levac et al. In the first step, six topics were identified through an international eDelphi consultation. In the next four steps, the scoping reviews were conducted. The sixth step was the VERDAS workshop held in Colombia in March 2017.DiscussionIn this article, we discuss several methodological issues encountered and share our reflections on this work. We believe this protocol provides a strong example of an exhaustive and rigorous process for performing broad knowledge synthesis for any given topic and should be considered for future research initiatives and donor agendas in multiple fields to highlight research needs scientifically.

Impact, economic evaluation, and sustainability of integrated vector management in urban settings to prevent vector-borne diseases: a scoping review

BackgroundThe control of vector-borne diseases (VBD) is one of the greatest challenges on the global health agenda. Rapid and uncontrolled urbanization has heightened the interest in addressing these challenges through an integrated vector management (IVM) approach. The aim was to identify components related to impacts, economic evaluation, and sustainability that might contribute to this integrated approach to VBD prevention.Main bodyWe conducted a scoping review of available literature (2000–2016) using PubMed, Web of Science, Cochrane, CINAHL, Econlit, LILACS, Global Health Database, Scopus, and Embase, as well as Tropical Diseases Bulletin, WHOLIS, WHO Pesticide Evaluation Scheme, and Google Scholar. MeSH terms and free-text terms were used. A data extraction form was used, including TIDieR and ASTAIRE. MMAT and CHEERS were used to evaluate quality.Of the 42 documents reviewed, 30 were focused on dengue, eight on malaria, and two on leishmaniasis. More than a half of the studies were conducted in the Americas. Half used a quantitative descriptive approach (n = 21), followed by cluster randomized controlled trials (n = 11). Regarding impacts, outcomes were: a) use of measures for vector control; b) vector control; c) health measures; and d) social measures. IVM reduced breeding sites, the entomology index, and parasite rates. Results were heterogeneous, with variable magnitudes, but in all cases were favourable to the intervention. Evidence of IVM impacts on health outcomes was very limited but showed reduced incidence. Social outcomes were improved abilities and capacities, empowerment, and community knowledge. Regarding economic evaluation, only four studies performed an economic analysis, and intervention benefits outweighed costs. Cost-effectiveness was dependent on illness incidence. The results provided key elements to analyze sustainability in terms of three dimensions (social, economic, and environmental), emphasizing the implementation of a community-focused eco-bio-social approach.ConclusionsIVM has an impact on reducing vector breeding sites and the entomology index, but evidence of impacts on health outcomes is limited. Social outcomes are improved abilities and capacities, empowerment, and community knowledge. Economic evaluations are scarce, and cost-effectiveness is dependent on illness incidence. Community capacity building is the main component of sustainability, together with collaboration, institutionalization, and routinization of activities. Findings indicate a great heterogeneity in the interventions and highlight the need for characterizing interventions rigorously to facilitate transferability.