Marta Aldea

The Willingness of Medical Students to Use Facebook as a Training Channel for Professional Habits: The Case of Influenza Vaccination

The low acceptance of influenza vaccination by both medical students and healthcare workers (HCWs) signals the need for innovative strategies. We administered an anonymous questionnaire to 410 University of Barcelona medical students who were asked about using the Internet to find information on influenza vaccination of HCWs and about their willingness to use technical and informal Facebook pages as an information channel on this topic. Of the 410 participants, 74.1 percent were female and 58.3 percent were in the first preclinical 3-year university cycle. A total of 7.6 percent participants reported using the Internet for queries on influenza vaccination, 89.8 percent reported that they were Facebook users, and 275 (67.1 percent) would accept an invitation from the technical or informal Facebook pages. The technical Web site would be actively followed by 77, or by 30.0 percent of those who would accept the invitation and the informal site by 116 (43.6 percent of those who would accept). The marked willingness to use Facebook to obtain information on the influenza vaccination of HCWs potentially opens a new window in health education: social networks could be used to help create professional habits. Students would be more likely to engage with this type of Facebook page if the contents were informal rather than highly technical.

Evaluating influenza vaccination campaigns beyond coverage: a before-after study among health care workers.

BACKGROUND Influenza vaccination campaigns based on educational interventions do not seem to increase coverage in the hospital setting, and their impact on educational goals is not usually evaluated. This study describes the campaign implemented in a university hospital and assesses the achievement of the strategic objectives, which were to increase health care workers (HCW) perceptions of the risk of influenza and of their role as promoters of influenza vaccination among their colleagues and to increase knowledge about influenza. METHODS A before-after study was conducted using a self-administered survey in a randomized sample of HCW during the 2010-2011 influenza vaccination campaign. The Wilcoxon paired measures test was used to assess attainment of the strategic objectives. RESULTS The campaign had a positive impact on the strategic objectives (Wilcoxon test, P value <.05 in all cases). The reach of the campaign was high (91.9%), and HCW rated it as positive (7.19 [standard deviation, 2.3] out of 10) but did not achieve increased coverage (34%; 95% confidence interval: 33.8-36.4). CONCLUSION Evaluation of the campaign shows that its effect responded to the strategic objectives. However, it seems that increasing the information provided to HCW and heightening their risk perception do not necessarily lead to greater acceptance of influenza vaccination.

Educating on professional habits: attitudes of medical students towards diverse strategies for promoting influenza vaccination and factors associated with the intention to get vaccinated

BackgroundInfluenza vaccination coverage in medical students is usually low. Unlike health care workers, there is little information on the attitudes to and predictors of vaccination among medical students, and their attitudes towards institutional strategies for improving rates are unknown.MethodsThis cross-sectional study evaluated the effect of three influenza vaccination promotional strategies (Web page, video and tri-fold brochure) on medical students’ intention to get vaccinated and associated factors. A total of 538 medical students were asked to answer an anonymous questionnaire assessing the intention to get vaccinated after exposure to any of the promotional strategies. Sociodemographic data collected included: sex, age, university year, influenza risk group and cohabiting with member of a risk group.ResultsFour hundred twenty-one students answered the questionnaire, of whom 312 (74.1%) were female, 113 (26.8%) had done clinical rotations, and 111 (26.6%) reported intention to get the flu shot. Logistic regression showed the web group had a greater intention to get vaccinated than the reference group (OR: 2.42 95% CI: 1.16-5.03). Having done clinical rotations (OR: 2.55 95% CI: 1.36-4.38) and having received the shot in previous flu seasons (OR: 13.69 95% CI: 7.86-23.96) were independently associated with the intention to get vaccinated.ConclusionGiven that previous vaccination is a factor associated with the intention to get vaccinated, education on vaccination of health care workers should begin while they are students, thereby potentiating the habit. In addition, the intention to get vaccinated was greater during the clinical phase of the university career, suggesting this is a good time to introduce promotion strategies. Online promotional campaigns, such as a thematic Web to promote vaccination of health workers, could improve the intention to get vaccinated.

Epidemiology of NMOSD in Catalonia: Influence of the new 2015 criteria in incidence and prevalence estimates

Background: Population-based studies on neuromyelitis optica spectrum disorders (NMOSD) are limited, and it is unclear whether the rates have changed with the implementation of the new 2015 criteria. Objectives: To estimate the incidence and prevalence of NMOSD in Catalonia (Spain), using both the 2006 and the 2015 criteria. Methods: In this clinic-based retrospective study, patients diagnosed with NMOSD between 2006 and 2015 were identified using multiple sources, including direct contact to all Catalan hospitals, identification of cases through the Catalan Health Surveillance System, and registry of antibodies to aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) in a reference laboratory. The incidence rate was calculated for the period 1 January 2006–1 January 2016 and prevalence for the date 1 January 2016. Results: We identified 74 patients (by the 2015 criteria). Most patients were Caucasian (81%), and female (76%) with a median age at disease onset of 42 years (range, 10–76 years). In total, 54 (73%) patients were positive for AQP4-IgG, 11 (15%) double-seronegative, and 9 (12%) MOG-IgG-positive. Rates of incidence and prevalence (0.63/1,000,000 person-years and 0.89/100,000, respectively) were 1.5-fold higher than those reported by the 2006 criteria. Lowest rates were seen in children and elder people and highest in women and middle-aged people (40–59 years). The female predominance was lost in incident AQP4-IgG-seronegative children and AQP4-IgG-positive elder people. MOG-IgG and double-seronegativity contributed similarly but did not influence the long-term outcome. Conclusion: The new criteria increase the estimates, but NMOSD remains as a rare disease. The differences in age- and sex-specific estimates highlight the importance of the serologic classification.

A public-professional web-bridge for vaccines and vaccination: User concerns about vaccine safety

Vacunas.org (http://www.vacunas.org), a website founded by the Spanish Association of Vaccinology offers a personalized service called Ask the Expert, which answers any questions posed by the public or health professionals about vaccines and vaccination. The aim of this study was to analyze the factors associated with questions on vaccination safety and determine the characteristics of questioners and the type of question asked during the period 2008-2010. A total of 1341 questions were finally included in the analysis. Of those, 30% were related to vaccine safety. Questions about pregnant women had 5.01 higher odds of asking about safety (95% CI 2.82-8.93) than people not belonging to any risk group. Older questioners (>50 years) were less likely to ask about vaccine safety compared to younger questioners (OR: 0.44, 95% CI 0.25-0.76). Questions made after vaccination or related to influenza (including H1N1) or travel vaccines were also associated with a higher likelihood of asking about vaccine safety. These results identify risk groups (pregnant women), population groups (older people) and some vaccines (travel and influenza vaccines, including H1N1) where greater efforts to provide improved, more-tailored vaccine information in general and on the Internet are required.

Formación sanitaria especializada: preferencias y percepciones de los estudiantes de medicina

El balance entre la oferta y la demanda de las plazas para la Formación Sanitaria Especializada (FSE) tiene implicaciones en el funcionamiento de los servicios de salud y en la sostenibilidad del sistema sanitario. La educación médica tiene un elevado coste, tanto para el estado, como para la familia del estudiante. En la toma de decisión sobre la especialidad a escoger se ven involucrados tanto los intereses del estudiante y su entorno más cercano, como los del sistema sanitario. Centrando la atención en el estudiante, existen diversos factores que se combinan en el momento de elegir especialidad de Médico Interno Residente (MIR). Como se ha demostrado en otros paı́ses, el sexo del estudiante se asocia a la elección de una u otra especialidad: proporcionalmente, las especialidades esencialmente quirúrgicas son más escogidas por los varones, excepto Ginecologı́a y Obstetricia que, como ocurre con la especialidad de Pediatrı́a, es mayormente escogida por las mujeres. La percepción de la calidad de vida y del prestigio profesional que la especialidad puede proporcionar tiene también su implicación en la elección. Estudios realizados en EE.UU. apuntan a la potencial mejor calidad de vida durante la práctica profesional como un factor determinante en la elección, quedando en un segundo plano especialidades que tradicionalmente conllevan un elevado número de guardias, como Cirugı́a General, Medicina Interna o Ginecologı́a y Obstetricia. Por otra parte, el prestigio profesional percibido, que se asocia a unos

Factors associated with risk behavior in travelers to tropical and subtropical regions

BACKGROUND Recent decades have seen a rise in population movements and, therefore, the spread of tropical diseases and changes in the epidemiology of global disease patterns. Only 50% of travelers to tropical areas receive pre-travel advice and most of them present risk behaviors for acquiring infections. The aim of this study was to describe the clinical and epidemiological characteristics of travelers and identify factors associated with risk behaviors. METHODS We made a retrospective, descriptive and analytical study of 772 travelers consulting a tropical medicine clinic in Barcelona in 2010. Data on demographic and clinical variables, travel characteristics and risk behaviors were collected. RESULTS Among all travelers studied, 65.8% (466/708) received pre-travel advice and 30.7% (209/680) took malaria prophylaxis. At least one risk behavior was reported by 82.6% (587/711) of travelers. People traveling for 1-6 months had a 3-fold higher likelihood of experiencing risk behaviors than people traveling for <1 month (95% CI 1.54-5.81, p=0.001), and those traveling for >6 months had a 13-fold higher likelihood (95% CI 3.11-56.14, p<0.001) compared with the same group. Increasing age was associated with presenting less risk behaviors. CONCLUSIONS Younger travelers and those making longer trips have a higher number of risk behaviors. Strategies emphasizing advice on risk behavior should focus on these groups.

Chronic proton pump inhibition therapy in the diagnostic accuracy of serum pepsinogen I and gastrin concentrations to identify pernicious anaemia

BACKGROUND Chronic use of proton pump inhibitors (PPIs) leads to increases in gastrin and pepsinogen-I serum concentrations. AIM To asses if chronic treatment with PPIs has an effect on serum gastrin and pepsinogen-I concentrations for the diagnosis of pernicious anaemia (PA). MATERIALS AND METHODS Serum gastrin and pepsinogen-I were measured in 38 patients with PA and 74 without PA (controls); 17/38 PA patients and 36/74 controls were treated with PPIs. Receiver Operating Curves (ROC) were used to compare diagnostic accuracy of gastrin and pepsinogen-I for PA in patients under chronic treatment with PPIs and in untreated patients. RESULTS PPI treatment increased pepsinogen-I in patients and in controls, while gastrin increased only in controls. In untreated patients, a pepsinogen-I <8.3ng/mL had 95.2% sensitivity and 100% specificity, whereas a gastrin >115pg/mL had 100% sensitivity and 92.11% specificity for PA diagnosis. In PPI-treated patients, a pepsinogen I<24.1ng/mL had a lower sensitivity (82.4%) but retained 100% specificity, however the best cut-off point for gastrin, 610pg/mL, had a very low sensitivity (58%). CONCLUSIONS PPI chronic treatment decreased the diagnostic accuracy for the studied biomarkers, particularly of gastrin. In PPI-treated patients, serum pepsinogen-I concentrations >24.1ng/mL allowed rejecting a PA diagnosis with 100% specificity.

Immunogenicity and immunization costs of adjuvanted versus non-adjuvanted hepatitis B vaccine in chronic kidney disease patients.

ABSTRACT Hepatitis B virus (HBV) vaccination is recommended for all susceptible chronic pre-hemodialysis and hemodialysis patients. This study assessed the immunogenicity of HBV vaccines (adjuvanted and non-adjuvanted) in chronic kidney disease patients vaccinated at the Hospital Clinic of Barcelona (Spain) between January 2007 and July 2012. In addition, the costs for the health system were evaluated accor-ding to the proportion of vaccine responders after receiving either vaccine. Patients receiving 3 doses of hepatitis B adjuvanted vaccine were 3 times more likely to seroconvert than patients immunized with non-adjuvanted vaccines, OR 3.56 (95% CI 1.84–6.85). This resulted in fewer patients requiring a second course of HBV vaccination and fewer outpatient visits, saving more than €9,500 per 100 patients. The higher immunogenicity of the adjuvanted HBV vaccine would counterbalance the lower costs associated with the non-adjuvanted vaccine.