José Luis del Barrio

Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? a systematic review

BackgroundThe Summit of Independent European Vaccination Experts (SIEVE) recommended in 2007 that efforts be made to improve healthcare workers’ knowledge and beliefs about vaccines, and their attitudes towards them, to increase vaccination coverage. The aim of the study was to compile and analyze the areas of disagreement in the existing evidence about the relationship between healthcare workers’ knowledge, beliefs and attitudes about vaccines and their intentions to vaccinate the populations they serve.MethodsWe conducted a systematic search in four electronic databases for studies published in any of seven different languages between February 1998 and June 2009. We included studies conducted in developed countries that used statistical methods to relate or associate the variables included in our research question. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. The data were descriptively analyzed.ResultsOf the 2354 references identified in the initial search, 15 studies met the inclusion criteria. The diversity in the study designs and in the methods used to measure the variables made it impossible to integrate the results, and each study had to be assessed individually. All the studies found an association in the direction postulated by the SIEVE experts: among healthcare workers, higher awareness, beliefs that are more aligned with scientific evidence and more favorable attitudes toward vaccination were associated with greater intentions to vaccinate. All the studies included were cross-sectional; thus, no causal relationship between the variables was established.ConclusionThe results suggest that interventions aimed at improving healthcare workers’ knowledge, beliefs and attitudes about vaccines should be encouraged, and their impact on vaccination coverage should be assessed.

Prevalence of dementia and major dementia subtypes in Spanish populations: A reanalysis of dementia prevalence surveys, 1990-2008

BackgroundThis study describes the prevalence of dementia and major dementia subtypes in Spanish elderly.MethodsWe identified screening surveys, both published and unpublished, in Spanish populations, which fulfilled specific quality criteria and targeted prevalence of dementia in populations aged 70 years and above. Surveys covering 13 geographically different populations were selected (prevalence period: 1990-2008). Authors of original surveys provided methodological details of their studies through a systematic questionnaire and also raw age-specific data. Prevalence data were compared using direct adjustment and logistic regression.ResultsThe reanalyzed study population (aged 70 year and above) was composed of Central and North-Eastern Spanish sub-populations obtained from 9 surveys and totaled 12,232 persons and 1,194 cases of dementia (707 of Alzheimers disease, 238 of vascular dementia). Results showed high variation in age- and sex-specific prevalence across studies. The reanalyzed prevalence of dementia was significantly higher in women; increased with age, particularly for Alzheimers disease; and displayed a significant geographical variation among men. Prevalence was lowest in surveys reporting participation below 85%, studies referred to urban-mixed populations and populations diagnosed by psychiatrists.ConclusionPrevalence of dementia and Alzheimers disease in Central and North-Eastern Spain is higher in females, increases with age, and displays considerable geographic variation that may be method-related. People suffering from dementia and Alzheimers disease in Spain may approach 600,000 and 400,000 respectively. However, existing studies may not be completely appropriate to infer prevalence of dementia and its subtypes in Spain until surveys in Southern Spain are conducted.

Riesgo coronario atribuible a los factores de riesgo cardiovascular en población española

Introduccion y objetivos La carga de enfermedad coronaria atribuible a los factores de riesgo cardiovascular en Espana ha sido extrapolada tradicionalmente de otras poblaciones. Este estudio pretende estimar el riesgo coronario atribuible al tabaquismo, la hipercolesterolemia, la hipertension, la diabetes y el sobrepeso, utilizando datos procedentes de poblaciones Espanolas. Metodos Las prevalencias de los factores de riesgo en la poblacion general se obtuvieron de un metaanalisis de 48 estudios transversales realizados en Espana, y las prevalencias en enfermos coronarios se tomaron de los registros hospitalarios multicentricos PRIAMHO II y PREVESE II. Los riesgos relativos brutos y ajustados de enfermedad coronaria se obtuvieron del seguimiento durante 5 anos de una cohorte de atencion primaria de 6.124 personas adultas libres de enfermedad cardiovascular. Las fracciones atribuibles brutas y ajustadas se calcularon para ambos sexos y para varones y mujeres por separado. Resultados En los varones, el 42,5% (intervalo de confianza [IC] del 95%, 6,8%-59,6%) de la incidencia ajustada de enfermedad coronaria se atribuyo al sobrepeso; el 33,9% (IC del 95%, 22,6%-41%), al tabaquismo, el 19,4% (IC del 95%, 8,2%-26,5%), a la hipercolesterolemia, y el 15,5% (IC del 95%, 1,6%-24,6%), a la hipertension. En las mujeres, el 36,5% (IC del 95%, –8%-56,3%) de los casos de cardiopatia isquemica se atribuyeron al sobrepeso, el 24,8% (IC del 95%, 12%-31,9%), a la diabetes y el 20,1% (IC del 95%, 6,1%-28,6%), a la hipercolesterolemia. Conclusiones El sobrepeso y el tabaquismo en varones son los factores de riesgo cardiovascular a los que cabe atribuir un mayor impacto poblacional en la enfermedad coronaria.

Dementia, stroke and Parkinson's disease in spanish populations: A review of door-to-door prevalence surveys

We identified 14 door-to-door prevalence surveys on dementia, parkinsonism or stroke in Spanish populations fulfilling specific criteria and combined selected age- and sex-specific data using logistic regression and taking Pamplona as a reference. The prevalence of dementia and of Alzheimer’s disease varied significantly with space. However, the largest variation was seen for vascular dementia: odds ratio (OR) and 95% confidence interval (CI) for Gerona were 6.42 (3.23–12.3) in women and 2.30 (1.10–4.79) in men. Stroke was particularly frequent among Arevalo’s women, with OR 2.10 and 95% CI 1.26–3.49. The prevalence of Parkinson’s disease was twofold higher in Cantalejo. Although differences in methodology make the interpretation of results problematic, the prevalence of stroke and vascular dementia in Spain seems to vary spatially, indicating a space for prevention.

Validación transcultural de la Escala de Sentido de Coherencia de Antonovsky (OLQ-13) en ancianos mayores de 70 años

Fundamento y objetivo El sentido de coherencia (SOC) es un constructo relacionado con el afrontamiento de situaciones traumaticas que se ha empleado extensamente como predictor de medidas de salud percibida y objetiva. El SOC es una disposicion personal hacia la valoracion de las experiencias vitales como comprensibles, manejables y significativas. Esta medida se ha mostrado especialmente informativa en poblaciones envejecidas, pese a lo cual la escala no se ha validado en poblacion espanola anciana. En este trabajo presentamos la validacion transcultural y el estudio de las propiedades metricas de la escala de SOC de Antonovsky, de 13 items (OLQ-13), en una muestra de poblacion de ancianos espanoles. Sujetos y metodo La muestra estuvo compuesta por 419 personas de mas de 70 anos procedentes de 8 localidades espanolas. Se estudiaron la aceptabilidad, asunciones escalares, consistencia interna, estructura factorial, validez de constructo (validez convergente, analisis diferenciales, correlacion entre dominios) y precision del instrumento. Resultados La consistencia interna de la escala fue adecuada (α de Cronbach = 0,80). El SOC mostro validez convergente con medidas autorreferidas de salud fisica, calidad de vida y depresion. La escala tambien demostro ser valida en sucesivos analisis diferenciales segun grupos de edad, sexo, niveles de discapacidad y de impacto funcional de enfermedades. El analisis de componentes principales ofrecio una solucion multifactorial con un porcentaje de la variancia explicada del 65,59%. La subescala de significacion parece formar un factor independiente. Conclusiones El OLQ-13 es una escala valida y fiable para su uso en poblaciones ancianas espanolas, incluidos grupos con bajo nivel de instruccion.

Stroke prevalence among the Spanish elderly: an analysis based on screening surveys

BackgroundThis study sought to describe stroke prevalence in Spanish elderly populations and compare it against that of other European countries.MethodsWe identified screening surveys -both published and unpublished- in Spanish populations, which fulfilled specific quality requirements and targeted prevalence of stroke in populations aged 70 years and over. Surveys covering seven geographically different populations with prevalence years in the period 1991–2002 were selected, and the respective authors were then asked to provide descriptions of the methodology and raw age-specific data by completing a questionnaire. In addition, five reported screening surveys in European populations furnished useful data for comparison purposes. Prevalence data were combined, using direct adjustment and logistic regression.ResultsThe overall study population, resident in central and north-eastern Spain, totalled 10,647 persons and yielded 715 cases. Age-adjusted prevalences, using the European standard population, were 7.3% for men, 5.6% for women, and 6.4% for both sexes. Prevalence was significantly lower in women, OR 0.79 95% CI 0.68–0.93, increased with age, particularly among women, and displayed a threefold spatial variation with statistically significant differences. Prevalences were highest, 8.7%, in suburban, and lowest, 3.8%, in rural populations. Compared to pooled Spanish populations, statistically significant differences were seen in eight Italian populations, OR 1.39 95%CI (1.18–1.64), and in Kungsholmen, Sweden, OR 0.40 95%CI (0.27–0.58).ConclusionPrevalence in central and north-eastern Spain is higher in males and in suburban areas, and displays a threefold geographic variation, with women constituting the majority of elderly stroke sufferers. Compared to reported European data, stroke prevalence in Spain can be said to be medium and presents similar age- and sex-specific traits.

Prevalence of disability in a composite ≥75 year-old population in Spain: A screening survey based on the International Classification of Functioning

BackgroundThe prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF.MethodsNine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2nd edition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100).ResultsThe age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32).ConclusionsDisability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.

Medical, environmental and personal factors of disability in the elderly in Spain: a screening survey based on the International Classification of Functioning

OBJECTIVES The International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability. METHODS Nine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2(nd) ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses. RESULTS The sample was composed of 503 participants aged ≥ 75 years. Alzheimeŕs disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74). CONCLUSIONS Disability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression.

Variedad y diversidad de la dieta de los niños españoles: Estudio Cuatro Provincias

Fundamento y objetivo Las guias de alimentacion saludable aconsejan una dieta variada. El objetivo de este estudio consistio en evaluar la relacion entre la variedad de la dieta y la calidad nutricional de la misma en ninos espanoles. Sujetos y metodo Estudio de caracter transversal en el que la informacion alimentaria y nutricional se recogio mediante un cuestionario de frecuencia de consumo de alimentos. La muestra incluyo a 1.112 ninos/as, de entre 6 y 7 anos, de Cadiz, Madrid, Orense y Murcia. La seleccion se realizo mediante muestreo aleatorio, por conglomerados de centros escolares. Calculamos el indice de variedad de la dieta (IVD), o numero de alimentos, y el indice de diversidad de la dieta (IDD), o numero de grupos alimentarios. La calidad global de la dieta se evaluo mediante el indice de alimentacion saludable (IAS-f). Resultados El porcentaje de ninos que consumieron una cantidad inferior a una racion diaria vario entre el 0% de los cereales y el 11,3% de la fruta. La variedad y la diversidad de la dieta se asociaron de forma positiva con la ingestion de fibra, vitaminas B6, E y acido folico, y con el porcentaje de ingestion calorica procedente de los acidos grasos insaturados e hidratos de carbono. Por el contrario, la asociacion fue negativa en el caso de la ingestion de lipidos totales, acidos grasos saturados, vitamina C, sodio y calcio. Aunque el IVD y el IDD presentaron una asociacion positiva con el IAS-f, al introducir ambos indices simultaneamente en un modelo de regresion el IDD fue el unico que contribuyo al ajuste del mismo (p Conclusiones Los resultados presentados apoyan las bondades de una dieta variada, entendida esta como la que incluye componentes de diferentes grupos alimentarios y, a su vez, mantiene la ingestion energetica en los niveles recomendados.